JOB SUMMARY: The Prescription Coordinator is a Certified Medical Assistant responsible for coordinating prescription-related messages, refill requests, prior authorizations, pharmacy communications and related medication workflows for MMHS Rural Health Clinics. The position works collaboratively with providers, clinical staff, clinic operations staff, pharmacies and patients to support timely, accurate and compliant prescription processing. The Prescription Coordinator performs assigned activities within established protocols and scope of practice and promptly routes requests requiring clinical judgment or prescriber authorization to the appropriate licensed clinician or prescribing provider.
PERFORMANCE DIMENSIONS AND TASKS
Essential Job Functions
The duties listed below are the essential functions of this position. Employees must be able to perform these essential functions, with or without reasonable accommodation. This list is intended to describe the primary responsibilities of the position and is not intended to be an exhaustive list of all duties. Additional job-related duties may be assigned as needed.
Prescription Messaging and Refill Processing
- Answer incoming telephone calls and monitor assigned prescription-related queues, inboxes, electronic pharmacy requests, patient messages, portal requests, faxes and other designated communication channels throughout the workday.
- Follow MMHS medication refill protocols before preparing or routing any refill request.
- Review available refill information, including medication name, strength, directions, pharmacy, last fill date, remaining refills, last relevant office visit and upcoming appointment information, as required by established protocol.
- Identify early refill requests, duplicate requests, refill timing concerns, medication discrepancies or other requests that fall outside established protocol and route them to the appropriate licensed clinician or prescribing provider for review.
- Electronically prepare and queue medication refill requests for provider approval in the electronic health record (EHR).
- Complete refill-request messages within the established 72-hour protocol or other applicable organizational timeframe and escalate time-sensitive issues according to clinic procedure.
- Resubmit prescriptions that were approved but not received by the pharmacy after verification of the issue and in accordance with established workflow.
- Monitor assigned prescription work queues to ensure requests are completed, appropriately routed, followed through and closed without unnecessary delay.
Appointment Coordination and Patient Communication
- Review whether the patient has been seen within the timeframe required by refill protocol and assist with scheduling an appointment when follow-up is needed.
- When permitted by established protocol, prepare a limited or bridge refill request for provider review to support continuity until the scheduled visit; the Prescription Coordinator does not independently determine or authorize medication quantities.
- Communicate with patients regarding refill status, need for an appointment, prior-authorization status, pharmacy issues or other provider-directed prescription information within the scope of the role.
- Provide clear instructions regarding next steps and route clinical questions, medication side-effect concerns, worsening symptoms or other clinical issues to the appropriate clinical staff or provider.
- Document patient communications and actions taken in the EHR according to MMHS policy.
Pharmacy and Medication Issue Coordination
- Communicate with pharmacies by telephone, fax, electronic messaging or other approved methods regarding medication changes, refill status, transmission issues or provider-directed information.
- Assist with non-clinical pharmacy issues such as medication availability, backorders, insurance rejection messages, quantity limitations or pharmacy changes and route requests requiring a medication substitution or other clinical decision to the prescribing provider.
- Clarify administrative or transmission issues using the medical record and established workflow without independently changing a medication, dose, frequency, quantity, formulation or therapeutic plan.
- Coordinate resolution of prescription issues with providers, MAs, nursing staff, clinic operations staff and pharmacies as appropriate.
Prior Authorization Coordination
- Assist with prior authorizations for prescription and point-of-care medications through payer, pharmacy-benefit and other approved electronic portals.
- Gather and submit available required documentation within the scope of the role, including medication history, diagnosis information, visit documentation or other information already documented in the medical record.
- Track prior-authorization requests through completion, respond to administrative payer requests and route requests for additional clinical justification to the prescribing provider or appropriate licensed clinician.
- Document authorization submissions, status updates, determinations and follow-up actions in the EHR and/or designated tracking system.
- Communicate approval, denial or additional-action requirements to the appropriate provider, clinic staff, pharmacy and patient as directed.
- For denied requests, route formulary-alternative or treatment-change decisions to the prescribing provider; the Prescription Coordinator does not independently select therapeutic alternatives.
340B and Program-Specific Prescription Workflow
- Monitor the 340B portal and perform assigned patient-match activities according to established MMHS 340B procedures.
- Verify documented patient, provider and eligible outpatient clinic relationships as required by assigned workflow and escalate uncertain or unmatched records for review.
- Maintain accurate documentation and follow organizational procedures designed to support 340B program integrity and compliance.
- Complete required education related to 340B, payer portals, prescription assistance workflows and other medication-related programs applicable to the position.
Documentation, Scope of Practice and Escalation
- Maintain accurate, timely and complete documentation of prescription-related communications, refill activity, pharmacy contacts, authorization activity and follow-up actions in the EHR or designated system.
- Protect patient privacy and confidentiality and comply with HIPAA, MMHS policies, payer requirements and applicable medication-management procedures.
- Perform prescription-coordination activities only within established protocols, assigned duties and CMA scope of practice.
- Do not independently authorize refills, prescribe medications, change medication doses or directions, select substitute medications, discontinue medications or make other clinical medication decisions.
- Promptly route requests requiring clinical assessment, interpretation, prescriber authorization or decisions outside the role to the appropriate licensed clinician or prescribing provider.
- Escalate urgent or time-sensitive medication issues according to established clinic workflow and immediately report patient-safety concerns to appropriate clinical staff.
Workflow Coordination, Quality and Performance Improvement
- Collaborate with providers, nursing staff, MAs, Patient Access, clinic operations staff, pharmacies and other departments to resolve prescription-related barriers and support continuity of care.
- Provide prescription-workflow support across MMHS Rural Health Clinic locations as assigned based on operational needs.
- Participate in refill-workflow audits, queue-aging review, prior-authorization tracking, error review, education, competency validation and other quality or performance-improvement activities.
- Report recurring workflow barriers, delays, medication-request trends, portal issues or other concerns to clinic leadership and assist with implementation of approved workflow improvements.
- Maintain proficiency in the EHR, prescription-management systems, insurance portals, 340B portal and other software required for the role.
Other Duties
- Respond to necessary changes in workflow or work assignment and perform other job-related duties as assigned.
- Use work time productively and support clinic operations within the scope of the role and training.
QUALIFICATIONS
Education
- Current certification/credentialing must be maintained as required by MMHS policy and applicable standards.
Licensing/Certification
- Certified Medical Assistant (CMA) from an accredited college or technical school - Required.
Work Experience
- Two (2) years of related healthcare experience in an outpatient clinic, Rural Health Clinic, medical office, prescription/refill workflow, prior authorization, pharmacy-related workflow, or comparable ambulatory setting - Preferred
- Experience using an electronic health record (EHR) and electronic prescription/refill workflows - Preferred
- Experience with medication prior authorizations, payer portals, and/or 340B workflows - Preferred
- Knowledge of medical terminology, prescription terminology, and common outpatient clinic workflows.
Knowledge, Skills and Abilities
- Knowledge of medical and prescription terminology and general outpatient clinic workflows.
- Knowledge of standard practices related to prescription/refill processing, medication prior authorizations, and coordination with pharmacies and payers.
- Skill in using electronic health record (EHR) systems, word processing, spreadsheets, databases, and web-based payer or pharmacy portals.
- Ability to manage multiple work queues and competing priorities while responding appropriately to time-sensitive requests.
- Ability to maintain accuracy and attention to detail while following established policies, procedures, protocols, and workflows.
- Ability to communicate clearly, professionally, and effectively with patients, providers, clinical staff, pharmacies, payers, and other internal and external contacts.
- Ability to organize work, maintain appropriate documentation, and follow tasks through to completion.
- Ability to maintain confidentiality and appropriately handle sensitive patient and organizational information.
- Ability to work independently and collaboratively as part of an interdisciplinary healthcare team.
- Ability to adapt to changing priorities, workflows, technology, and operational needs.
Language Requirements
- Bilingual English/Spanish - Required
Physical Requirements
- Ability to sit, stand and walk intermittently during the workday.
- Ability to use hands repetitively for keyboarding, scanning, telephone and other office-equipment tasks for extended periods.
- Ability to view computer screens and perform detailed data-entry and documentation tasks for extended periods, with normal breaks.
Working Conditions
- Work is primarily performed in a Rural Health Clinic/medical office environment and requires frequent use of computers, telephones and electronic communication systems.
- Requires sustained attention to detail and accuracy while managing repetitive and time-sensitive prescription workflows.
- May work in proximity to patients with communicable illness and must follow MMHS infection prevention, PPE and exposure-control policies.
- Must maintain confidentiality and professional boundaries when handling protected health information and medication-related information.
DISCLAIMER:
The preceding job description has been designed to indicate the general nature and level of work performed. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job.