Medication Access Specialist
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Skills
buy-and-billprior authorization
About the role
Description
About CLS Health
CLS Health is a growing healthcare system in Houston, Texas that is taking a different approach to healthcare. We are a physician-led healthcare group that focuses on providing patients with holistic, multispecialty care. We're a dynamic team on a mission to provide better healthcare options for Houstonians!
Position Summary
Owns the end-to-end access process for specialty and infused medications across the infusion center and pharmacy. The right candidate knows the drugs, the payers, and the manufacturer programs, and can get a medication from order to first treatment with no gaps.
Responsibilities:
- Receive and review medication orders from referring providers
- Complete benefits investigation (medical vs pharmacy benefit) and determine coverage and patient financial responsibility
- Determine routing for each order: buy and bill through the infusion center or specialty pharmacy, based on payer requirements
- Submit and follow prior authorizations through payer and portal workflows, including appeals and peer-to-peer coordination
- Enroll patients in copay card programs, manufacturer portals, foundation assistance, and patient assistance programs (PAP) for free drug
- Coordinate medication sourcing with the pharmacy and distributor and confirm product and biosimilar selection per payer formulary
- Schedule initial treatments and hand off to clinical staff
- Track authorization expirations and reauthorizations
Benefits:
- 401(k) matching
- Dental Insurance
- Disability insurance
- Health insurance
- Life insurance
- Paid time off
Requirements
- 3+ years in medication access, prior authorization, or specialty pharmacy intake, preferably in an infusion or specialty clinic setting
- Working knowledge of J-codes, biosimilars, buy and bill, specialty pharmacy, and medical vs pharmacy benefit
- Hands-on experience with copay assistance portals, manufacturer hub programs, and PAP applications
- Familiarity with major commercial, Medicare Advantage, and Medicaid payer policies for specialty drugs
- Strong organization and follow-through; comfortable managing a high volume of open cases
- Pharmacy technician certification or similar is a plus