Part-Time Medication Access Specialist – Ophthalmology
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Job Description
Certified ophthalmic technician managing medication access for Duke Health ophthalmology patients. Handling prior authorizations, payer barriers, assistance programs, and Epic documentation remotely.
Responsibilities:
- Review medication-access requests from Epic In Basket, electronic prior-authorization tools, patient calls, MyChart, refill/RxChange messages, fax, clinics, staff assistants, email, and real-time messaging
- Validate medication, prescriber, indication, pharmacy, benefit, urgency, and requested action
- Differentiate prior authorization, formulary, step-therapy, quantity, tier, refill, claim-processing, specialty-pharmacy, documentation, and affordability barriers
- Research plan-specific criteria and preferred submission routes
- Prepare and submit requests, retrieve and interpret determinations, respond to deficiencies, coordinate reconsiderations and appeals, track deadlines, and escalate documentation needs
- Review diagnoses, notes, medication history, prior trials, contraindications, allergies, treatment response, and discrepancies
- Obtain prescriber clarification without independently making treatment decisions
- Communicate status and next steps and clarify claim, brand/NDC, quantity, day supply, refill, and specialty-routing details
- Verify whether approval results in a payable and affordable prescription
- Screen for manufacturer copay programs, patient assistance programs, direct-to-consumer options, Medicare Extra Help, specialty pathways, and cash alternatives
- Maintain Epic documentation, process determination letters, update case status, close the loop with responsible parties, and support workload/outcome reporting
Requirements:
- Completion of Ophthalmic Technician training
- Certification as a certified Ophthalmic Technician by the Joint Commission on Allied Health Personnel in Ophthalmology (JCAHPO)
- BLS Certification
- Knowledge of ophthalmic terminology, eye diseases, ocular emergencies, ophthalmic medications, and treatment protocols
- Ability to assess patient symptoms, recognize urgent and emergent ophthalmic conditions, and prioritize care using established clinical guidelines
- Strong critical thinking and clinical decision-making skills
- Excellent verbal and written communication skills
- Ability to work effectively in a remote, team-based environment
- Proficiency documenting patient encounters, triage assessments, recommendations, and communications in an electronic medical record
- Ability to manage multiple priorities simultaneously
- Ability to work independently, exercise sound judgment, and use available resources to resolve patient care issues
- Knowledge of patient privacy, confidentiality, regulatory requirements, and HIPAA compliance
- Strong organizational and time-management skills
- Ability to provide patient education and reinforce provider instructions
- Ability to participate in continuous process improvement and adapt to evolving workflows
- Able to withstand long sitting
- Candidate must reside in North Carolina or have plans to relocate to North Carolina
- Must be available for a varying schedule of 19 hours per week
Benefits:
- Equal Opportunity Employer committed to providing employment opportunity without discrimination
- Reasonable accommodation information and provisions available
- Remote work arrangement
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