State Operations Coverage Specialist

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

📋 Description

• Verify that all services, providers, and medications are included in the network for both Employer-Sponsored Insurance (ESI) and Fee-for-Service (FFS) Medicaid.

• Address coordination of benefits concerns.

• Assist families in obtaining prior authorizations when necessary.

• Resolve pharmacy-related issues and aid families in acquiring medications as required.

• Engage in team meetings and ensure follow-up actions are completed.

• Carry out additional duties as required.

• Facilitate daily operational tasks for PFA's Pennsylvania team.

⛳️ Requirements

• A high school diploma or GED is required.

• Completion of formal training or coursework in healthcare administration, patient services, or a related field is preferred.

• A minimum of 2 years' experience in insurance verification, prior authorization, Medicaid or managed care, pharmacy benefits, or revenue cycle management is necessary.

• Capability to read and interpret drug formularies and Summary of Benefits documents.

• Strong verbal and written communication abilities.

• Proficient time management and organizational skills.

• Keen attention to detail.

• Innovative problem-solving skills.

• Preferred: A Bachelor's degree in healthcare administration, patient services, or a relevant field.

• Preferred: 3 to 5 years of pertinent experience, particularly with Pennsylvania Medicaid or the PA HIPP program.

• Preferred: In-depth knowledge of Pennsylvania Managed Care Medicaid, Medical Assistance, and the PA HIPP program.

• Preferred: Extensive experience in obtaining prior authorizations.

🏝️ Benefits

• Employer-subsidized medical coverage.

• Supplemental cost-offset benefit to alleviate out-of-pocket expenses at the point of care.

• Dental coverage.

• Vision coverage.

• Company-paid life insurance effective from day one.

• Company-paid disability insurance effective from day one.

• 401(k) retirement program with up to a $2,000 annual match.

• Flexible spending accounts.

• Employee Assistance Program.

• Wellness benefit.

• Benefits supporting eligible dependents.

• Remote work options available.