Pharmacy Care Coordinator

UnitedHealth Group • Norwood, MA

6d • Remote

About The Position

Responsible for navigating requests for the prior authorization of medications not covered by a patient’s insurance in accordance with insurance provider guidelines. Serves as an expert on subject matters for medication prior authorizations and maintains a solid understanding of healthcare insurance policies, drug information, pharmacy benefit management, and medical terminology.
Schedule: Monday – Friday, 8am – 4:30pm
Location: This role is Remote in Massachusetts. If you are located within a commutable distance to an Atrius office nearest to you, you will have the flexibility to work remotely as you take on some tough challenges.

Requirements

• High School Diploma/GED
• 1+ years of Pharmacy Technician or prior authorization experience
• 1+ years of experience using Microsoft systems

Nice To Haves

• Bachelor’s or Associate’s degree in medical assisting or graduate of certificate program preferred with commensurate pharmacy experience and pharmacy knowledge
• Previous experience with Pharmacy management or EMR software and operational platforms

Responsibilities

• Responsible for communicating directly with patients, insurance companies, providers, clinical pharmacists and pharmacies to support timely review and processing of prior authorization requests for new and refill prescriptions
• Acquires and maintains a working knowledge of health plan formulary and authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization
• Develops proficiencies in utilization of Epic in accordance with department standard work guidelines
• Verifies patient’s demographics, insurance eligibility and prescription benefit information required to process new and refill prescriptions, where permitted by state law
• Gathers all necessary information from chart review and identifies correct forms needed to submit prior authorization request to insurance providers
• Works as a patient advocate and functions as a liaison between the patient and payer to answer routine and complex inquiries, reimbursement questions, and avoid insurance delays
• Communicates with providers and patients to provide updates on the status of their prior authorizations or appeals
• Provides prompt feedback to physicians and management regarding issues with medication authorization denials and health plan recommendations and or alternatives when provided by the insurance company
• Assists patients with financial assistance for high copay medication utilizing manufacturer coupons, manufacturer patient assistance programs or provides patient with the appropriate Med Cost Savings Form and collaborates with Clinical Pharmacists as necessary
• Acquires and maintains a working knowledge of drug manufacturer patient assistance programs to include drug manufacturer coupons/vouchers and has knowledge of how to access them
• Ability to perform all tasks of a pharmacy care coordinator and other similar and related duties to assist with staff cross coverage as required or directed by the supervisor
• Provides superior phone services and quality customer service to ensure the highest level of patient satisfaction
• Interacts effectively and professionally with all patients, prescribers, payors, pharmacies and all location departments of Atrius Health
• Ability to work quickly and accurately on an independent basis with great attention to detail, and displaying initiative to quickly identify and resolve variances and discrepancies
• Follows all professional and departmental guidelines for PHI and HIPPA compliance and with all relevant laws, regulations, and policies related to medication prior authorizations
• Actively contributes to the evaluation and continuous improvement of the prior authorization process as well as department projects, prescription initiatives, policies, and procedures
• Complies with established departmental policies, procedures, and objectives
• Enhances professional growth and development through educational programs, seminars, etc.
• Follows all downtime and emergency processes per departmental policies
• Regular, reliable and predicable attendance is required

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED