State Operations Coverage Specialist

Patient Funding Alternatives • Woburn, MA

2d

About The Position

The State Operations Coverage Specialist handles day-to-day operational work in support of PFA's Pennsylvania team. The role confirms that the services, providers, and medications families need are in network and resolves coordination of benefits issues so families can obtain the care and medications they need. Success requires strong problem-solving, close attention to detail, and a willingness to build deep knowledge of Pennsylvania Medicaid and the PA HIPP program.

Requirements

• High school diploma or GED, and completion of formal training or coursework in healthcare administration, patient services, or a similar field.
• At least 2 years of experience in insurance verification, prior authorization, Medicaid or managed care, pharmacy benefits, or revenue cycle.
• Ability to read and analyze drug formularies and Summary of Benefits documents.
• Excellent verbal and written communication skills.
• Effective time management, organizational skills, and attention to detail.
• Creative problem-solving skills.

Nice To Haves

• Bachelor's degree in healthcare administration, patient services, or a related field.
• 3 to 5 years of experience in insurance verification, prior authorization, Medicaid or managed care, pharmacy benefits, or revenue cycle, ideally with Pennsylvania Medicaid or the PA HIPP program.
• Extensive knowledge of Pennsylvania Managed Care Medicaid, Medical Assistance, and the PA HIPP program.
• Extensive knowledge of obtaining prior authorizations.

Responsibilities

• Confirm that services, providers, and medications are in network with both Employer-Sponsored Insurance (ESI) and Fee-for-Service (FFS) Medicaid.
• Resolve coordination of benefits issues.
• Help families obtain prior authorizations as needed.
• Resolve pharmacy issues and help families obtain medications as needed.
• Participate in team meetings and complete follow-ups.
• Perform other duties as needed.

Benefits

• Employer-subsidized medical coverage
• Supplemental cost-offset benefit to help reduce out-of-pocket expenses at the point of care
• Dental coverage
• Vision coverage
• Company-paid life and disability insurance effective day one
• 401(k) retirement program with up to a $2,000 annual match
• Flexible spending accounts
• Employee Assistance Program
• Wellness benefit

What This Job Offers

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