Job Description

Job Description

Job Description

Description:

ABOUT VISANTE
We are a specialized consulting firm focused on helping hospitals and health systems accelerate strong clinical, operational, and financial performance through pharmacy. Our team of professionals brings deep, contemporary expertise and innovation to optimizing all aspects of a fully integrated health system pharmacy program, driving significant value quickly.

Our mission is to transform healthcare through pharmacy, and our vision is to reimagine pharmacy to improve lives.

Visante is looking to add a Medication Specialist to our Specialty Pharmacy Services line. This individual will be responsible for

providing medication access and affordability services to Visante clients and their patients.

ABOUT THE ROLE (Remote, work from home)
The Medication Specialist’s responsibilities include the following:

• Reviewing medication authorizations submitted by clients
• Performing appropriate actions based on client and patient needs, including:
  • Identifying the process to submit authorizations
  • Reviewing documentation in the client’s medical record that is required for authorization submissions
  • Performing benefits investigation reviews to determine patient coverage and out-of-pocket costs
  • Identifying patient assistance programs, copay cards, grants, or funds that could be utilized to reduce patient financial burdens
  • Communicating with the clinic to obtain additional information or guidance related to prior authorization submission
  • Assisting clinics with submitting appeals related to coverage denials
• Communicates determinations and relevant follow-up with patients on behalf of clients, including:
  • Sharing information related to medication coverage and financial assistance options
  • Providing pharmacy options for where prescriptions can be filled
• Ensuring timely and accurate documentation related to services provided to clients and their patients by appropriately documenting information in clients’ EMR systems based on the agreed-upon Visante-client workflow and documenting information in Visante systems for tracking prior authorization volumes and associated fees
• Supporting clients with onboarding and training of client-employed medication access specialists, when directed and supporting Visante with continual process improvement and client-specific workflow and process development
• Collaborating with Visante team members and leaders to provide insight and constructive feedback into day-to-day operations
• Supporting clients with improving clinical staff and client pharmacy workflows and communications
• Completing other duties as assigned by the supervisor

Education

Required: High school diploma or equivalent

Experience

Required: 3 years of experience working within healthcare or with pharmacy providers on medication access

Preferred: Previous consulting and/or client-facing experience; Experience with electronic medical record documentation and prior authorization workflows; Experience with performing retail pharmacy PBM adjudication; Experience in utilizing CoverMyMeds® to submit prior authorizations; Two (2) years of experience in healthcare revenue cycle that includes medication authorizations; Knowledge of CPT and ICD coding is highly desired; Knowledge of Medicare and third-party payer regulations and guidelines is highly desired; Two (2) years of experience in preadmission/precertification

Skills and Abilities

Demonstration of good judgment, multi-tasking and meeting deadlines with a sense of urgency, and being able to prioritize competing demands; Strong client relationship, interpersonal, and team skills; Proven ability to diagnose and resolve issues, demonstrating strong analytical and creative skills; Ability to make sound and timely decisions based on analysis, experience, and judgment; Clear and concise verbal and written communication skills and the ability to advise clients professionally and positively; Maintains confidentiality of all patient-related information; Excellent knowledge of medication reimbursement and healthcare prior authorization/coding ; Excellent knowledge and proficiency in MS Word, Outlook, PowerPoint, and Excel

Compensation and Benefits: We offer competitive salary and benefits for this full-time salaried role.

Equal Opportunity Statement: Visante is an equal opportunity employer. Visante’s people are its greatest asset and provide the resources that have made the company what it is today. Visante is, therefore, committed to maintaining an environment free of discrimination, harassment, and violence. This means there can be no deference because of age, religion or creed, gender, gender identity or expression, race, color, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by applicable laws and regulations

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