Pharmacy Coordinator - Specialty Pharmacy

Carilion Clinic Retail Pharmacy•Roanoke, VA

1d•Onsite

About The Position

The Specialty Pharmacy Coordinator provides specialty pharmacy intake, insurance verification, prior authorization, and reimbursement support for complex and high-cost medications. This role works collaboratively with patients, pharmacists, providers, and clinical teams to ensure required documentation, coverage determination, and financial assistance processes are completed to support timely initiation and continuation of therapy. The Coordinator independently manages assigned patient cases while delivering high-quality customer service and maintaining accurate documentation within specialty pharmacy systems.

Requirements

High school diploma or equivalent required.
Minimum of 3 years of pharmacy or healthcare revenue cycle experience
Virginia Board of Pharmacy registration.
Certified Pharmacy Technician (CPhT) required
Knowledge of government and commercial insurance, specialty pharmacy workflows, strong customer service, problem-solving, and system proficiency

Responsibilities

Provides initial patient onboarding and account setup for specialty pharmacy services, including intake of referrals, therapy changes, and service requests.
Enters, updates, and maintains accurate patient, insurance, benefits, and authorization data in pharmacy and care management systems.
Communicates with patients throughout onboarding and therapy to obtain required information, explain processes, and provide status updates.
Conducts insurance, benefits, and financial investigations to determine coverage, prior authorization, and reimbursement requirements.
Completes initial and renewal prior authorization submissions and tracks approval status.
Communicates approvals, denials, delays, and next steps to patients, providers, pharmacists, and internal teams.
Identifies patient financial assistance needs and facilitates enrollment in copay, manufacturer, or patient assistance programs.
Collaborates with pharmacists and providers to obtain clinical documentation and letters of medical necessity.
Assists patients with billing questions, outstanding balances, and payment arrangements in accordance with established guidelines.
Responds to incoming phone calls and electronic communications and resolves customer inquiries and concerns.
Runs and reviews standard departmental reports to support audit, compliance, and revenue monitoring.
Identifies opportunities for workflow efficiency and process improvement within assigned responsibilities.
Maintains confidentiality and complies with regulatory, accreditation, and organizational requirements.