Pharmacy Clinical and Financial Access Coordinator; Mount Sinai Health System; Full Time; Days; Hybrid

Mount Sinai Health System•New York, NY

2d•Hybrid

About The Position

Under the direction of the Director of Pharmacy and Pharmacy leadership, the Clinical and Financial Access Coordinator supports patients and clinical teams by facilitating access to medications through insurance prior authorizations, benefits investigations, scheduling coordination, care plan implementation, and financial assistance programs. The role interacts with pharmacists, medical and clinical staff, finance and billing personnel, and third-party payers to ensure timely medication access and accurate reimbursement.

Requirements

High School Diploma or GED
Minimum 1 year of retail or specialty pharmacy technician experience preferred
3 years of healthcare billing and/or managed care reimbursement, or related administrative experience preferred
Familiarity with payer plans, PBMs, Medicare/Medicaid, and copay assistance resources
Pharmacy Technician registration with the New York Board of Pharmacy preferred upon hire
PTCB Certification required
Strong oral and written communication skills
Excellent organizational skills and attention to detail
Ability to multitask in a fast-paced environment
Effective interpersonal skills with internal and external stakeholders
Sound judgment and ability to follow established protocols
Commitment to high standards of patient confidentiality and customer service

Nice To Haves

Associate degree or higher

Responsibilities

Receive and triage prescriptions, ensuring accurate patient and insurance information.
Complete third-party payer prior authorization requests, including medical necessity documentation and follow-up with providers and insurers.
Resolve claim rejections and provide product overrides when necessary.
Provide patient education and address benefit inquiries as necessary.
Process and document applications for Patient Assistance Programs (PAPs) and co-pay support.
Conduct benefit verification and pharmacy benefit checks at provider request.
Coordinate patient visits with clinical pharmacists and care team.
Obtain the patient’s medication history.
Assist with care plan implementation and resolution of medication adherence barriers.
Refer patients via telephonic encounters to fill medications at Mount Sinai-owned pharmacies.
Maintain compliance with HIPAA, payer requirements, and Board of Pharmacy regulations.
Provide exceptional customer service through phone, email, and EHR messaging with patients and healthcare teams.
Maintain detailed documentation of all activities and outcomes.
Supervise, mentor, and train Clinical and Financial Access Coordinators and billing staff; promote teamwork and accountability.
Oversee completion and quality of prior authorizations and reimbursement activities to maximize revenue capture for high-cost medications.
Review outpatient prescriptions for payer routing and specialty network requirements; coordinate with appropriate pharmacy entities.
Prepare reports and analytics on workflow performance, prior authorization turnaround, and PAP utilization.
Serve as a liaison to pharmaceutical manufacturers, vendors, and accrediting bodies.
Participate in audits, accreditation reviews, and quality assurance initiatives.
Escalate complex payer or coverage issues and assist with appeals.
Support with Open Enrollment activities as necessary.
Support special projects and process improvement initiatives.
Perform other related duties as assigned.