Description
Join St. Joseph Regional Medical Center in Lewiston, Idaho—where nationally recognized quality meets small-town heart. We’re proud to be recognized for excellence and patient safety, including an “A” Hospital Safety Grade from The Leapfrog Group, inclusion in Becker’s list of “Great Community Hospitals,” and U.S. News & World Report accolades for maternity care. Here, you’ll find a teamwork-first culture, leaders who support you, and coworkers who genuinely have your back. New grads are welcome—we’re committed to training, mentoring, and helping you build confidence as you grow. And because we know great care starts with taking care of our people, we offer competitive benefits and a workplace you can feel good about. If you’re looking for a place to do meaningful work, build a career, and feel proud serving your community—you belong at St. Joe’s.
Job Summary
The Medication Access Specialist facilitates timely patient access to prescribed medications by coordinating insurance prior authorizations, benefits investigations, financial assistance programs, and specialty pharmacy services. This role serves as a liaison between patients, providers, payers, pharmacies, pharmaceutical manufacturers, and internal departments to minimize barriers to treatment, optimize reimbursement, and support continuity of care. The Medication Access Specialist maintains accurate documentation, ensures regulatory compliance, and provides exceptional customer service throughout the medication access process.
Essential Functions
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Coordinates insurance prior authorizations, precertifications, and appeals to obtain timely approval for prescribed medications.
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Performs insurance benefits investigations and verifies patient eligibility, coverage, and financial responsibility.
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Assists patients with enrollment in manufacturer-sponsored patient assistance, copay assistance, foundation grants, and other financial assistance programs.
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Coordinates medication fulfillment with specialty pharmacies, infusion providers, payers, and internal clinical teams to ensure timely initiation and continuation of therapy.
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Serves as the primary point of contact for patients regarding medication access, insurance requirements, financial assistance, and treatment status.
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Collaborates with physicians, advanced practice providers, nurses, pharmacists, revenue cycle, and external organizations to resolve medication access barriers.
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Maintains accurate and timely documentation within the electronic health record and other required systems.
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Monitors authorization status, renewals, expiring approvals, and payer requirements to prevent interruptions in therapy.
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Educates patients regarding medication access processes, financial assistance resources, and required documentation while maintaining patient confidentiality.
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Identifies and escalates reimbursement, authorization, or access issues requiring clinical or leadership intervention.
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Maintains current knowledge of payer policies, specialty medications, pharmaceutical assistance programs, and regulatory requirements impacting medication access.
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Participates in quality improvement initiatives, process optimization, and departmental performance goals.
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Ensures compliance with HIPAA, organizational policies, payer requirements, and applicable federal and state regulations.
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Assists with reporting, tracking productivity metrics, and maintaining required records related to medication access activities.
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Performs other duties as assigned.
Knowledge/Skills/Abilities/Expectations
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Knowledge of insurance benefits, prior authorization, reimbursement, and specialty pharmacy processes.
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Knowledge of pharmaceutical manufacturer assistance and financial assistance programs.
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Strong customer service, interpersonal, and relationship-building skills.
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Excellent verbal and written communication skills.
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Ability to manage multiple priorities while meeting deadlines in a fast-paced environment.
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Strong analytical, organizational, and problem-solving abilities.
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Proficiency with electronic health records, payer portals, Microsoft Office, and other healthcare technology applications.
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Ability to maintain confidentiality and exercise sound judgment with sensitive patient information.
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Ability to work independently while collaborating effectively with interdisciplinary teams.
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Commitment to providing compassionate, patient-centered service.
Qualifications
Education
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High School Diploma or Equivalent including education equivalent to completion of secondary school or demonstrated ability to perform the essential functions of the role.
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Associate’s Degree Healthcare Administration, Business, Pharmacy Technology, Nursing, or a related field (Preferred)
Licenses/Certifications
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PHAR-C - Certified Pharmacy Tech (CPhT) National pharmacy technician certification from an accredited certifying body (PTCB or NHA) Upon Hire (Preferred)
Experience
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2+ years experience in medication access, specialty pharmacy, oncology, prior authorization, revenue cycle, pharmacy operations, or healthcare financial counseling (Preferred)
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Prior Experience with electronic health records, payer portals, and specialty pharmacy workflows (Preferred)
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Prior Experience in oncology or infusion services (Preferred)
