Medication Access Specialist

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