Prior Authorization Specialist

This is a fully remote position, open to applicants in Massachusetts.

📋 Description

• Process and submit prior authorizations for FQHCs collaborating with C3/CPC.

• Assist in managing patients who need prior authorizations.

• Conduct insurance benefit investigations, offer copay assistance, provide foundation support, and manage the dispensing of specialty medications.

• Identify and assess patients eligible for medication assistance programs and foundations.

• Communicate effectively with providers, patients, pharmacy, and health center teams.

• Collaborate with administrators of drug-manufacturer reimbursement assistance programs.

• Monitor, document, and report cost savings linked to patient assistance drug recovery programs.

• Provide updates to pharmacy management.

• Advise patients on available patient assistance programs, including manufacturer coupons when applicable.

• Adhere to departmental and CPC guidelines and policies.

• Interact with patients in a friendly and welcoming manner.

• Accurately update demographic, insurance, and allergy information.

• Resolve insurance-related matters, including prior authorizations, and assist patients with financial aid.

• Remain stationary 50–75% of the time and regularly exert up to 20 pounds of force.

⛳️ Requirements

• Proficiency in submitting prior authorizations to PBMs.

• Capability to manage processes and create implementation strategies.

• Prior experience in a pharmacy, retail, medical, or customer service environment.

• Knowledge of Microsoft Word and Excel.

• Strong analytical and organizational abilities, including the capacity to analyze data for trend identification and communicate findings through effective reporting.

• Exceptional attention to detail.

• Excellent oral, written, and verbal communication skills, with experience presenting complex information to senior leaders.

• Ability to exercise a high level of initiative, judgment, discretion, and decision-making to achieve goals.

• Current licensure as a pharmacy technician in the Commonwealth of Massachusetts.

• At least 1 year of experience in submitting prior authorizations on behalf of a medical center.

• GED or High School diploma is required.

• Employees must be vaccinated in accordance with applicable law.

🏝️ Benefits

• Vaccination consistent with applicable law required as an employment condition.