Prior Authorization Specialist
Community Care Cooperative•Boston, MA
•$68,806 - $80,847•Remote
About The Position
This position will be housed under a subsidiary organization of C3, Community Pharmacy Cooperative, LLC (CPC). The Prior Authorization Specialist is responsible for processing and submitting prior authorizations on behalf of FQHCs working with C3/CPC. Meeting the pharmacy related needs of the ACO and its members is the focus of CPC. The Prior Authorization Specialist’s duties include ensuring that prior authorizations are submitted in an accurate and efficient manner, communicating with providers, patients, and health center pharmacy teams to optimize patient care.
Requirements
- Expertise in prior authorization submission to PBMs
- Ability to manage processes and develop implementation strategies
- Previous experience in a pharmacy, retail, medical, or customer service setting
- Familiarity with Microsoft Word and Excel
- Strong analytical and organizational skills including ability to analyze data to identify trends and communicate them through effective reporting methods
- Strong attention to detail
- Excellent oral, written, and verbal communication skills including experience presenting complex information to senior leaders
- Skilled in exercising a high degree of initiative, judgement, discretion, and decision making to achieve objectives
- Current licensure in Commonwealth of Massachusetts as a pharmacy technician
- 1 year experience in submitting prior authorizations on behalf of a medical center
- GED or High School diploma required
Nice To Haves
- Familiarity with the MassHealth ACO program
- Familiarity with Federally Qualified Health Centers
- Experience with anti-racism activities, and/or lived experience with racism is highly preferred
Responsibilities
- Support the management of patients requiring prior authorizations
- Provide prior authorization services, including insurance benefit investigation, copay assistance, foundation support, and insourcing the dispensing function of Specialty Medications
- Identify and qualify patients eligible for medication patient assistance programs and foundations
- Communicate with providers, patients, pharmacy and health center teams in a professional and efficient manner
- Interface with program administrators for reimbursement assistance programs sponsored by the drug manufacturer
- Track, document, and report cost savings associated with patient assistance drug recovery programs and provide updates to pharmacy management
- Provide guidance to patients on patient assistance programs (e.g. provide manufacturer coupons to patients, if available)
- Follow all applicable departmental and CPC Policies and Procedures (as they pertain to operations, quality assurance, goals and priorities)
- Communicate with patients in a friendly, welcoming manner with greeting provided by management
- Complete updating accurate demographic information such as address, date of birth, insurance information and allergies
- Resolve insurance related issues, including prior authorizations, and assist patients with various forms of financial assistance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
