[Hiring] Prior Authorization Specialist @Community Care Cooperative (C3)

Role Description

This position will be housed under a subsidiary organization of C3, Community Pharmacy Cooperative, LLC (CPC). The Prior Authorization Specialist is responsible for processing and submitting prior authorizations on behalf of FQHCs working with C3/CPC. Meeting the pharmacy related needs of the ACO and its members is the focus of CPC. The Prior Authorization Specialist’s duties include:

• Supporting the management of patients requiring prior authorizations.
• Providing prior authorization services, including:
  • Insurance benefit investigation
  • Copay assistance
  • Foundation support
  • Insourcing the dispensing function of Specialty Medications
• Identification and qualification of patients eligible for medication patient assistance programs and foundations.
• Communicating with providers, patients, pharmacy, and health center teams in a professional and efficient manner.
• Interfacing with program administrators for reimbursement assistance programs sponsored by the drug manufacturer.
• Tracking, documenting, and reporting out cost savings associated with patient assistance drug recovery programs and providing updates to pharmacy management.
• Providing guidance to patients on patient assistance programs (e.g., providing manufacturer coupons to patients, if available).
• Following all applicable departmental and CPC Policies and Procedures (as they pertain to operations, quality assurance, goals, and priorities).
• Customer Service - communicating with patients in a friendly, welcoming manner with greeting provided by management.
• Completion of updating accurate demographic information such as address, date of birth, insurance information, and allergies.
• Resolving insurance-related issues, including prior authorizations, and assisting patients with various forms of financial assistance.

Qualifications

• Current licensure in Commonwealth of Massachusetts as a pharmacy technician.
• 1 year experience in submitting prior authorizations on behalf of a medical center.
• GED or High School diploma required.

Requirements

• Expertise in prior authorization submission to PBMs.
• Ability to manage processes and develop implementation strategies.
• Previous experience in a pharmacy, retail, medical, or customer service setting.
• Familiarity with Microsoft Word and Excel.
• Strong analytical and organizational skills including the ability to analyze data to identify trends and communicate them through effective reporting methods.
• Strong attention to detail.
• Excellent oral, written, and verbal communication skills including experience presenting complex information to senior leaders.
• Skilled in exercising a high degree of initiative, judgement, discretion, and decision making to achieve objectives.

Desired Other Skills

• Familiarity with the MassHealth ACO program.
• Familiarity with Federally Qualified Health Centers.
• Experience with anti-racism activities, and/or lived experience with racism is highly preferred.

Benefits

• In compliance with Infection Control practices per Mass.gov recommendations, we require all employees to be vaccinated consistent with applicable law.