When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
The In-Clinic Specialty Medication Access Coordinator is responsible for fulfilling all core job functions while providing dedicated coordination and advanced support for one or more specialty clinics. This position plays a pivotal role in supporting healthcare providers and patients by ensuring timely and seamless access to complex, high-cost, and specialty therapies essential to patient care and quality outcomes.
Serving as the primary on-site liaison between providers, patients, and pharmacy, the specialist holds expanded responsibility for enhancing utilization of BILH pharmacy services. The specialist will be expected to proactively identify patients who would benefit from integrated pharmacy support, educate providers and patients on the advantages of internal pharmacy coordination, and leads initiatives that strengthen medication access, adherence, and continuity of care.
In close collaboration with the Medication Authorization & Access (MAA) team, the specialist independently manages prior authorizations, insurance approvals, and financial assistance processes while resolving complex access barriers in real time. This highly visible, patient-facing role requires advanced clinical insight, operational efficiency, and strong communication skills to optimize patient outcomes, improve provider satisfaction, and advance system-level pharmacy integration across the BILH network.
Job Description:
Essential Responsibilities
-
Serves as the on-site subject matter expert for providers, clinic staff, and pharmacy teams on prior authorizations, reimbursement, and patient assistance for complex and specialty therapies.
-
Independently manages pharmacy and medical benefit authorizations, identifying formulary alternatives and ensuring timely approvals that support continuity of care.
-
Oversees insurance authorization and financial clearance for specialty and infusion medications, providing cost estimates and preventing treatment delays.
-
Coordinates patient enrollment and ongoing support in manufacturer or financial assistance programs to ensure affordability and uninterrupted therapy access.
-
Leads administration of the Employee Variable Co-Pay Program and advocates for patients through direct collaboration with manufacturers, PBMs, and specialty pharmacies.
-
Delivers high-level customer service and communication, maintaining proactive contact with patients, providers, and pharmacies to resolve access barriers efficiently.
-
Acts as the primary point of contact for benefits, clinical coordination, and program eligibility inquiries, streamlining processes across stakeholders.
-
Drives operational efficiency and quality improvement, independently resolving complex cases and advancing best practices within the clinic.
-
Develops and maintains strategic relationships with payers, manufacturers, and specialty partners to anticipate and navigate policy or coverage changes.
-
Provides mentorship and training to Medication Authorization and Access team members and supports cross-coverage across specialty and primary care clinics.
Required Qualifications
1. High School diploma or GED required.
2. Pharmacy Technician License (Massachusetts) – Massachusetts Board of Pharmacy
3. PTCB National Certification
4. Must obtain PACS certification within six months of hire.
5. 5 years related work experience required in specialty pharmacy and pharmacy prior authorization experience.
6. Proven track record of successfully managing stakeholder relationships and driving service adoption.
Preferred Qualifications
1. Leadership or training experience within a pharmacy, clinic, or medication access program.
2. Familiarity with 340B and integrated health system pharmacy models.
3. Comprehensive clinical knowledge of therapies used in specialty disease states (e.g., MS, RA, GI, transplant, oncology, hepatitis C, or infectious diseases including HIV).
4. Advanced Certificate Pharmacy Technician credential (CPhT-Adv).
5. Experience implementing process improvement or access optimization initiatives within a health system or specialty pharmacy setting.
Competencies
Decision Making: Ability to make decisions that are guided by precedents, policies and objectives. Regularly makes decisions and recommendations on issues affecting a department or functional area.
Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.
Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.
Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.
Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.
Knowledge: Ability to demonstrate in-depth knowledge of concepts, practices and policies with the ability to use them in complex varied situations.
Team Work: Ability to act as a team leader for small projects or work groups, creating a collaborative and respectful team environment and improving workflows. Results may impact the operations of one or more departments.
Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations.
Pay Range:
$33.60 – $45.22
The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law.
