Medication Access Coordinator

Position Highlights:

• Position: Medication Access Coordinator
• Hourly Pay Range: $19.89 - $28.84. The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors.
• Location: 1051 W Rand Rd. Arlington Heights, IL.
• Full Time: 40 hours/week
• Hours: Hours vary - Monday - Friday (8:30a-5p).

What you will do:

Reporting to the Specialty Management team, the Ambulatory Specialty Medication Access Coordinator works with Specialty nurses, physicians, patients, their representatives, insurance carriers and employers to determine benefits eligibility, benefits verification, and prior authorization requirements for high-cost medications used in the Medical Group Specialty as well as in home or infusion clinic. The Ambulatory Specialty Medication Access Coordinator screens registration data for compliance to ensure optimal reimbursement for high-cost medications and assists with denials and failed claims to ensure maximum reimbursement.

• Expedites authorizations for high dollar medications that are given in the office, home, or infusion clinic and exceeds patients' expectations for obtaining needed medications and therapies.
• Works with insurance carriers to determine patient's eligibility and benefits for high cost pharmaceuticals though medical coverage or pharmacy benefit depending on patient's plan. Performs benefit verifications and pre-authorization requirement to obtain medications and/or prior authorization for patients.
• Works with patient's specialty pharmacy to obtain medications if patient's plan so requires. Researches patient chart to obtain and document medical necessity working with prescribing physician when needed to obtain prior authorization. Prepare letters of medical necessity drafts for prescribing physician as needed.
• Reviews and analyzes all required demographic, insurance/financial, and clinical data procured by patient intake and registration areas necessary to obtain high dollar medications while maximizing reimbursement for those drugs and therapies. Resolves all issues including obtaining information and signatures on documents required by the patient's insurance carrier. Interacts, via telephone and in person, with patients, their representatives, physicians, physician's office staff, employers, and others, and reviews new and previously recorded patient, insurance and procedural information. Electronically records all phone interactions and records resolution to follow-up items in a timely manner. Follows HIPAA, payer, and applicable regulations and standards.
• Acts as a liaison between patients, physicians, and insurance companies to pre-authorize all medication therapies per insurance contract requirements. Notifies patients, physicians and ancillary departments regarding therapies that are potentially not covered and recommends enrollment into patient assistance plans when applicable.
• Assists with clinic workflow and improves patient care by collaborating with specialty nurses to prevent interruptions or delays in treatment due to insurance issues.
• Researches denials including missing authorization, pre-determination or referral documentation. Works on denied accounts by assisting with appeals submissions. Identifies, researches, and secures authorization for unspecified, new or unlisted medications or treatments to procure payment from insurance carriers.
• Utilizes EPIC Scheduling reports, reviewing specified physician ordered tests/ procedures/medications, ensuring the integrity of registration and CPT codes.
• Serves as a team representative at NCH MG Specialty meetings and provides input and recommendations on documentation issues with the patient's need as priority. Researches and analyzes case problems and participates in quality and process improvement initiatives as appropriate. Provides feedback into insurance carrier trends for specialty medication prescribing and authorization requirements.
• Adheres to all Northwest Community Hospital standards, policies, and procedures and reports compliance concerns to management staff.

What you will need:

• Education: The level of knowledge normally obtained through the completion of four years of high school. Degree in healthcare preferred.
• Certification: BLS/CPR Certification for the Healthcare Provider required

• Experience: Minimum 1 year experience working with specialty pharmacies and insurance companies to obtain medications and prior authorizations. Minimum of 2 years previous healthcare or related experience and familiarity with payer requirements, regulatory compliance requirements, HIPAA privacy and security requirements, medical terminology and general revenue cycle procedures required. Prior pharmacy experience preferred.

Benefits:

• Premium pay for eligible employees
• Career Pathways to Promote Professional Growth and Development
• Various Medical, Dental, and Vision options
• Tuition Reimbursement
• Free Parking
• Wellness Program Savings Plan
• Health Savings Account Options
• Retirement Options with Company Match
• Paid Time Off and Holiday Pay
• Community Involvement Opportunities
• Visa Sponsorship Available (Nursing and Lab roles)

Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals - Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) - all recognized as Magnet hospitals for nursing excellence. For more information, visit www.endeavorhealth.org.

When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.

Please explore our website (www.endeavorhealth.org) to better understand how Endeavor Health delivers on its mission to "help everyone in our communities be their best".

Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information.

Diversity, equity and inclusion is at the core of who we are; being there for our patients and each other with compassion, respect and empathy. We believe that our strength resides in our differences and in connecting our best to provide community-connected healthcare for all.

EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.