Performance Planning Reporting to the Assistant Director of Pharmacy Outpatient Services, the Specialty Pharmacy Access & Assistance Coordinator is responsible for the full scope of specialty medication access, dispensing, and patient financial navigation. This position consolidates the prior authorization, benefit verification, and specialty dispensing functions of the Medication Access Specialist role with the drug recovery and patient assistance program (PAP) functions of the Medication Assistance Program Coordinator role.
The Coordinator proactively reviews patients’ drug benefit information, secures manufacturer and foundation funding for patients who qualify, manages specialty medication orders and shipments, and maintains the documentation required to support URAC and ACHC accreditation standards. The role works directly with pharmacists, providers, payers, and patients to ensure timely, affordable access to specialty medications.
Responsibilities Key Responsibilities /
Medication Access & Prior Authorization Proactively review and verify patients’ drug benefit information within the electronic medical record (EMR) and pharmacy computer system. Conduct third-party prior authorization requests, including complex oncology and specialty drug authorizations. Process test claims for medications and maximize revenue capture for high-cost take-home medications through third-party (external) medication authorization.
Communicate directly with providers, payers, and patients regarding coverage determinations and appeals. Patient Assistance & Drug Recovery Initiate, research, complete, submit, and track Patient Assistance Program (PAP) applications for assigned facilities. Identify and qualify patients for medication patient assistance and drug recovery programs; locate, apply for, and secure funding from pharmaceutical manufacturers and foundations.
Manage patient enrollment in medication assistance programs and coordinate ongoing eligibility; maintain files and documentation for PAP submissions. Ensure pharmaceutical assistance is maintained for the duration of the prescription for enrolled patients, and identify assistance programs using third-party software and manufacturer portals. Specialty Dispensing & Order Management Dispense specialty medications and manage the full specialty pharmacy dispensing workflow.
Manage and coordinate all activities associated with Specialty Orders, including cold-chain and time-sensitive oncology agents. Track shipment orders and specialty medication deliveries. Maintain an accurate inventory of patient-specific medication provided through patient assistance programs.
Documentation & Accreditation Support Complete documentation required for URAC and ACHC accreditation compliance, including chart audits, temperature logs, and policy-adherence tracking. Support 340B program compliance and documentation. Perform insurance audits and monitor outstanding claims to support revenue cycle integrity. 5.
General Support Proactively build and maintain relationships with hospital contacts, providers, and other department managers, keeping them informed of changes affecting medication access and recovery. Report regularly to the Assistant Director on program status and any barriers to maximizing medication access and recovery opportunities. Other duties as assigned to support departmental goals and operational efficiency.
DCH Standards: Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation. Performs compliance requirements as outlined in the Employee Handbook. Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.
Performs essential job functions in a manner that ensures the safety of patients, visitors and employees. Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees. Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.
Requires use of electronic mail, time and attendance software, learning management software and intranet. Must adhere to all DCH Health System policies and procedures. All other duties as assigned.
Qualifications Minimum Knowledge, Skills, Experience Required Registration/Certification: Active Alabama Pharmacy Technician registration required by start date. National certification by PTCB or ExCPT required. Required: Minimum of two years of combined experience in medication reimbursement, health care insurance prior authorization, and/or patient assistance program coordination, reflecting the consolidated scope of this role.
Preferred: Three or more years of pharmacy practice experience. Experience with specialty pharmacy dispensing and drug recovery/patient assistance programs preferred. Baccalaureate degree strongly preferred.
Technical: Proficient in Microsoft Office, pharmacy dispensing systems, and third-party reimbursement/PAP software platforms. Professional: Strong communication and interpersonal skills; strong telephone presence and etiquette. Execution: Detail-oriented with strong follow-up skills; able to work under pressure and meet deadlines; better-than-average working knowledge of medications and medication classes.
Must be able to read, write legibly, speak, and comprehend English. Working Conditions WORK CONTEXT Environmental Exposure to contaminants Exposure to hazardous conditions Close physical proximity Requires wearing common protective or safety equipment Psychological Contact with others Occasionally deal with unpleasant or angry people Daily use of electronic mail Engage in face to face discussions Frequent use telephone Work with group or team PHYSICAL FACTORS Physical activities include: Talking, hearing, bending, twisting, walking, kneeling, crouching, stooping, climbing, balancing, reaching, pushing, pulling, lifting, grasping, repetitive motion, standing, and/or using hands to handle, control, or feel objects, tools or controls).
Light work. Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg controls requires exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated for light work.
Must be able to perform the duties with or without reasonable accommodation. Must be able to tolerate prolonged periods of sitting and/or standing Hearing and vision must be normal or corrected to within normal range. Possible exposure to disease, infection and hazardous materials.
Physical presence onsite is essential. OTHER JOB FACTORS Must be pleasant with others on the job and displaying a good-natured, cooperative attitude. Must be reliable, responsible, and dependable, and fulfill obligations.
Must be able to file and maintain records. Must be careful about detail and be thorough in completing work tasks Must be willing to take on responsibilities and challenges. Must be honest and ethical.
Must be able to accept criticism and deal calmly and effectively with high stress situations.