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About the Role
The Pharmacy Medication Support Specialist (MSS) facilitates prescription prior authorization (PA) and refill requests. This role involves obtaining, preparing, and submitting necessary forms for insurance authorizations, requesting information on alternative therapies, and communicating PA status to patients. The MSS also evaluates refill requests based on protocol criteria, reviews patient medical records, and explores financial assistance options to ensure medication access.
Responsibilities
- Drives the Prior Authorization (PA) process to completion and resolves any related issues under pharmacist oversight.
- Performs medication benefits investigation and accurately submits prior authorizations to insurance manually, electronically, or telephonically.
- Notifies the patient and documents the status of the PA and financial assistance in APeX.
- Follows up with health insurance payors for non-responsive PA requests.
- Works with pharmacists or providers for any denials and appeals.
- Evaluates patient assistance program opportunities.
- Receives and processes refill requests from clinic personnel, a pharmacy, or patients.
- Evaluates refill requests for adherence to refill protocol criteria by reviewing APeX and contacting patients.
- Notifies the pharmacist of specific refill protocol criteria not met after assessment.
- Notates the need for a provider appointment where applicable.
- Discusses recommendations and other pertinent information with the pharmacist.
- Searches for and analyzes EMR for needed lab tests to fulfill the protocol and informs patients about them.
- Pends orders or requests for provider appointments based on pharmacist judgment via APeX.
- Properly documents each refill request in the patient’s chart.
- Assists in training and onboarding new staff and learners regarding refill and PA processes.
- Participates in the pharmacy’s continuous quality improvement.
- Completes training requirements timely and stays up-to-date on policies and procedures.
- Performs additional tasks as deemed appropriate or necessary by the supervisor/manager pertaining to pharmacy operations and patient care.
Requirements
- Flexibility to orient and work at all UCSF Medical Center locations.
- Completion of a recognized/accredited Pharmacy Technician Training Program.
- Minimum of three (3) years of experience as a Pharmacy Technician or allied healthcare professional in a hospital, pharmacy, or other healthcare setting, or an equivalent combination of education and experience.
- Strong computer skills, including proficiency in Microsoft Office.
- Ability to prioritize work efficiently.
- Excellent interpersonal communication and writing skills, with the ability to work effectively with a large, diverse population.
- Excellent organizational and problem-solving skills.
- Ability to multitask and remain flexible when work assignments change at short notice.
- Basic math skills.
Skills
- Microsoft Office proficiency
- Interpersonal communication
- Writing skills
- Organizational skills
- Problem-solving skills
- Multitasking
- Flexibility
- Basic math skills
- Third-party billing
- Prior authorization facilitation
- Refill authorization
- Bilingual in Spanish, Cantonese, and/or Russian
- EMR usage
- Chart abstraction into EMR (APeX)
- Adaptability
- Willingness to learn new technologies
Location
- UCSF Medical Center locations
Work Type
- Full-time
Experience Level
- Minimum of three (3) years of experience
Education Level
- Completion of a recognized/accredited Pharmacy Technician Training Program
- Bachelor's degree in health or behavioral science (Preferred)
- Medical Assistant Certification (Preferred)
Benefits
- Total compensation details available at https://ucnet.universityofcalifornia.edu/compensation-and-benefits/index.html
About the Company
- UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.
- It is the only campus in the 10-campus UC system dedicated exclusively to the health sciences.
- UCSF brings together the world’s leading experts in nearly every area of health.
- UCSF is home to five Nobel laureates who have advanced the understanding of cancer, neurodegenerative diseases, aging and stem cells.
- UCSF is a diverse community made of people with many skills and talents.
- UCSF is committed to equity – both in how we deliver care as well as our workforce.
- UCSF is committed to building a broadly diverse community, nurturing a culture that is welcoming and supportive, and engaging diverse ideas for the provision of culturally competent education, discovery, and patient care.
Equal Opportunity
- The University of California is an Equal Opportunity Employer.
- All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law.