The Pharmacy Infusion Access Hub Technician is responsible for ensuring patient access to infusion and injectable medications by managing insurance benefits, prior authorization requirements, payer formulary reviews, claims follow-up, and affordability barriers. This role coordinates with pharmacists, providers, care teams, insurance companies, patient access teams, and revenue cycle partners to ensure timely medication access, accurate documentation, and appropriate reimbursement.
Key responsibilities include:
- Verifying insurance coverage and identifying prior authorization requirements with precision and attention to detail
- Reviewing medication benefit information and supporting formulary and billing code accuracy
- Gathering and organizing documentation from medical records to support claims and authorization processes
- Monitoring authorization and claims status to ensure timely resolution and patient access
- Managing appeals and processing denied claims in accordance with payer requirements
- Resolving barriers that may delay patient care through systematic problem-solving and escalation procedures
- Maintaining compliance with payer, institutional, and regulatory requirements
- Identifying and implementing workflow improvement initiatives within the infusion access hub to enhance operational efficiency and accuracy
EDUCATION/EXPERIENCE REQUIRED:
- Requires high school diploma or G.E.D. equivalent.
- Requires at least two (2) years of experience as an inpatient pharmacy technician (for inpatient setting) OR two (2) years of experience as a pharmacy technician for all others.
- Two (2) years of experience with automated pharmacy dispensing systems preferred.
- PC skills as needed to perform job functions as assigned. Strong verbal/written skills; availability for on-call system support; highly analytical ability to solve complex technical problems.
- Ability to work designated shifts, including weekends and holidays. Ability to function in a fast-paced environment with established time constraints.
- Flexibility to deal with ever-changing health care environment. Ability to effectively manage multiple projects.
CERTIFICATIONS/LICENSURES REQUIRED:
- Valid State of MI pharmacy technician licensure required.