Company Overview:

Join an innovative startup health plan based in Wisconsin that is revolutionizing healthcare and empowering companies to combat the relentless rise in healthcare costs. Our mission is to provide accessible, high-quality healthcare solutions while driving down costs for businesses over 50 in Wisconsin. As part of our small yet dynamic team, you'll have the opportunity to make a significant impact in shaping the future of healthcare in our beautiful state, which currently ranks top 5 in the highest healthcare costs in the country.

Position Overview:

The Medication Access Specialist is responsible for facilitating patients' access to prescribed medications by navigating insurance benefits, resolving barriers to coverage, and providing support to patients and healthcare providers. This role requires excellent communication skills, knowledge of insurance processes, and a patient-centered approach to ensure timely and affordable access to medications.

Key Responsibilities:

• Assist patients in understanding their medication coverage, including copayments, deductibles, and out-of-pocket costs.
• Provide education on medication assistance programs, including pharmaceutical manufacturer assistance, foundation support, and other resources.
• Communicate with patients to gather necessary information for medication access and follow-up on ongoing medication needs.
• Verify insurance benefits and coverage for prescribed medications.
• Obtain prior authorizations and handle appeals for medication coverage denials.
• Liaise with insurance companies, pharmacy benefit managers, and other third-party payers to resolve coverage issues.
• Work closely with physicians, pharmacists, and other healthcare professionals to ensure accurate and timely submission of prior authorization requests and appeals.
• Provide updates to healthcare providers on the status of medication access issues.
• Offer recommendations for alternative medications when coverage issues arise.
• Maintain detailed and accurate records of all interactions, authorizations, and follow-up actions.
• Ensure compliance with all applicable regulations, policies, and procedures related to medication access and patient privacy.
• Stay updated on changes in insurance policies, medication assistance programs, and relevant healthcare regulations.
• Identify and implement process improvements to enhance the efficiency and effectiveness of medication access services.
• Participate in training and continuing education opportunities to maintain and enhance skills and knowledge.

Qualifications:

• High school diploma or equivalent required; Associate’s or Bachelor’s degree in healthcare, pharmacy, or related field preferred.
• Minimum of 2 years of experience in a healthcare setting, preferably in a pharmacy, insurance, or patient advocacy role.
• Familiarity with insurance processes, medication assistance programs, and healthcare regulations.
• Strong communication and interpersonal skills.
• Detail-oriented with excellent organizational and problem-solving abilities.
• Proficiency in using healthcare-related software and databases.
• Ability to handle sensitive information with confidentiality and professionalism.

Preferred Qualifications:

• Certification as a Pharmacy Technician (CPhT) or related certification.
• Experience with electronic health records (EHR) and pharmacy management systems.
• Bilingual skills, particularly in Spanish or another language commonly spoken in the community.

Benefits:

• Competitive salary with uncapped commission potential.
• Membership to a Direct Primary Care of your choice
• Opportunity for professional growth and advancement within a rapidly growing startup.
• Collaborative and supportive work environment with a focus on innovation and creativity.
• Flexible work arrangements and remote work options available.

Join us in our mission to transform healthcare and make a positive impact on the lives of businesses and individuals in Wisconsin. If you're passionate about sales, healthcare, and driving meaningful change, we want to hear from you! Apply now to join our dynamic team.

Self Fund Health is an equal opportunity employer.