Pharmacy Care Coordinator - Remote in Massachusetts

Primary Responsibilities

• Navigate requests for the prior authorization of medications not covered by a patient's insurance in accordance with insurance provider guidelines.
• Serve as an expert on subject matters for medication prior authorizations and maintain a solid understanding of healthcare insurance policies, drug information, pharmacy benefit management, and medical terminology.
• Communicate directly with patients, insurance companies, providers, clinical pharmacists, and pharmacies to support timely review and processing of prior authorization requests for new and refill prescriptions.
• Acquire and maintain a working knowledge of health plan formulary and authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization.
• Verify patient’s demographics, insurance eligibility, and prescription benefit information required to process new and refill prescriptions, where permitted by state law.
• Gather all necessary information from chart review and identify correct forms needed to submit prior authorization request to insurance providers.
• Work as a patient advocate and function as a liaison between the patient and payer to answer routine and complex inquiries, reimbursement questions, and avoid insurance delays.
• Communicate with providers and patients to provide updates on the status of their prior authorizations or appeals.
• Provide prompt feedback to physicians and management regarding issues with medication authorization denials and health plan recommendations and/or alternatives when provided by the insurance company.
• Assist patients with financial assistance for high copay medications utilizing manufacturer coupons, manufacturer patient assistance programs, or provide the appropriate Med Cost Savings Form and collaborate with Clinical Pharmacists as necessary.
• Acquire and maintain a working knowledge of drug manufacturer patient assistance programs, including drug manufacturer coupons/vouchers, and have knowledge of how to access them.
• Perform all tasks of a pharmacy care coordinator and other similar and related duties to assist with staff cross coverage as required or directed by the supervisor.
• Provide superior phone services and quality customer service to ensure the highest level of patient satisfaction.
• Interact effectively and professionally with all patients, prescribers, payors, pharmacies, and all location departments of Atrius Health.
• Demonstrate excellent attention to detail and strong organizational skills, as well as problem-solving abilities.
• Contribute to the evaluation and continuous improvement of the prior authorization process as well as department projects, prescription initiatives, policies, and procedures.
• Comply with established departmental policies, procedures, and objectives.
• Enhance professional growth and development through educational programs, seminars, etc.
• Follow all downtime and emergency processes per departmental policies.

Requirements

• High School Diploma/GED
• 1+ years of Pharmacy Technician or prior authorization experience
• 1+ years of experience using Microsoft systems
• Reside in Massachusetts

Preferred Qualifications

• Bachelor's or Associate's degree in medical assisting or graduate of certificate program preferred with commensurate pharmacy experience and pharmacy knowledge
• Experience with Pharmacy management or EMR software and operational platforms

Benefits

• Competitive base pay
• Full and comprehensive benefit program
• Performance rewards
• Management team who demonstrates commitment to your success
• Medical Plan options
• Dental, Vision, Life & AD&D Insurance
• Short-term disability and Long-term disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

About the Role

Be part of our vision to transform care and improve lives by building trust, understanding, and shared decision-making with every patient. Join us and discover the meaning behind Caring. Connecting. Growing together.

Qualifications

• High School Diploma/GED
• 1+ years of Pharmacy Technician or prior authorization experience
• 1+ years of experience using Microsoft systems
• Reside in Massachusetts

Skills

• Excellent attention to detail and strong organizational skills required
• Must demonstrate excellent customer service and communication skills as well as problem-solving abilities

Benefits

• Competitive base pay
• Full and comprehensive benefit program
• Performance rewards
• Management team who demonstrates commitment to your success
• Medical Plan options
• Dental, Vision, Life & AD&D Insurance
• Short-term disability and Long-term disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

Pay

The hourly pay for this role will range from $18 - $32 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Schedule

Monday - Friday, 8:30am - 5:00pm

Location

This role is Remote in Massachusetts.