[Hiring] Medication Access Specialist @Duke University

Role Description

We are seeking a Medication Access Specialist (Ophthalmic Technician, Certified) to manage a high-volume, interruption-sensitive caseload across multiple ophthalmology subspecialties and locations. The role determines the true medication barrier, gathers and evaluates supporting information, completes payer requirements, coordinates next steps, and follows each request to a documented resolution. Success requires sound judgment, careful attention to detail, comfort with changing payer rules, and the ability to communicate clearly with both clinical and non-clinical partners.

Job Duties and Responsibilities

• Review requests from various sources including Epic In Basket, electronic PA tools, patient calls, MyChart, refill/RxChange messages, fax, clinics, staff assistants, email, and real-time messaging.
• Validate the medication, prescriber, indication, pharmacy, benefit, urgency, and requested action.
• Differentiating PA, 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 accurate requests; retrieve and interpret determinations; respond to deficiencies; coordinate reconsiderations and appeals; track deadlines; and escalate clinical 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; clarify claim details, brand/NDC, quantity, day supply, refill timing, and specialty routing; 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 appropriate cash alternatives.
• Maintain concise, complete Epic documentation; process determination letters; update case status; close the loop with responsible parties; and support workload/outcome reporting.

Qualifications

• Completion of Ophthalmic Technician training and 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 appropriately prioritize care using established clinical guidelines.
• Strong critical thinking and clinical decision-making skills with the ability to independently evaluate patient concerns and determine appropriate disposition and escalation.
• Excellent verbal and written communication skills, with the ability to communicate clearly, professionally, and compassionately with patients, families, physicians, scheduling staff, and other healthcare team members.
• Ability to establish and maintain effective working relationships in a remote, team-based environment.
• Proficiency in documenting patient encounters, triage assessments, recommendations, and communications accurately and thoroughly within the electronic medical record.
• Ability to manage multiple priorities simultaneously, including incoming patient calls, electronic messages, provider requests, and real-time communications from scheduling teams.
• Demonstrates ability to work independently, exercise sound judgment, and effectively utilize available resources to resolve patient care issues.
• Knowledge of patient privacy, confidentiality, and regulatory requirements, including HIPAA compliance.
• Strong organizational and time-management skills with the ability to maintain accuracy and productivity in a fast-paced remote environment.
• Ability to provide patient education and reinforce provider instructions regarding eye conditions, treatments, medications, postoperative care, and symptoms requiring urgent evaluation.
• Ability to participate in continuous process improvement initiatives and adapt to evolving workflows, protocols, and departmental needs.
• Able to withstand long sitting.

Job Hours

The schedule for this position is day shifts, Monday-Friday, with no weekends or holidays.