Pharmacy Benefit Specialist

About the role

The Pharmacy Benefits Specialist II, OPD is responsible for completing all pharmacy prior authorizations for outpatient medications. Serves as a liaison between the multiple disease centers at Dana-Farber, BWH oncology patients, pharmacy, and health insurance company representatives.

Responsibilities

• Process prior authorizations for all prescription medications written for all hematology and oncology patients at the Dana-Farber and Brigham and Women’s Hospital by Dana-Farber providers.
• Receive work and initiate prior authorizations upon communications from providers, pharmacy or other pharmacy benefit specialists.
• Provide patient information to insurance companies as needed and in accordance with HIPAA regulations as well as other state, federal and DFCI/BWH guidelines.
• Adjudicate approved claims via access to EnterpriseRx for prescriptions fillable in any of our outpatient pharmacies.
• Communicate with pharmacists, pharmacy, prescribers, and care team, to validate information when needed and share prior authorization approval status and delay information.
• Collect and communicate co-payment information to the care team.
• Coordinate mail-order discharge meds at the Brigham.
• Document daily and/or update each prior authorization in a centralized tracking database and/or worksheet.
• Support DFCI prescribers of Celgene products with REMS program patient registration, authorization numbers, and refill tracking as needed.
• Triage work as needed to Pharmacy Benefit Specialist I staff members.
• Aid in the re-balancing of workload assignments, as coordinated by the manager, to help cover PTO and other time off requests.

Qualifications

• Demonstrates proficiency in technical skills, ability to work in various computing/information systems and Microsoft Office product suite.
• Knowledge of basic retail pharmacy claims adjudication processes.
• Knowledge of hospital EMR functionality, including patient charts and in-basket messaging.
• Well organized and able to multi-task quickly and effectively.
• Excellent organizational, time management and interpersonal skills.
• Excellent written and verbal communication skills.
• Strong team-building character and positive attitude.
• Motivated, shows initiative and collaborates well in a team setting.
• Ability to work as an effective member of an interdisciplinary team.
• Ability to work closely and effectively with peers, coworkers, visitors, and management across the organization.
• Ability to function in a busy work setting and works well in high-pressure situations.
• Ability to be flexible and meet the needs of a growing department.