Prior Authorization Specialist
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Job Description
Prior Authorization Specialist processing pharmacy prior authorizations for C3’s FQHC healthcare network. Supporting patient assistance, insurance resolution, and specialty medication access.
Responsibilities:
- Process and submit prior authorizations on behalf of FQHCs working with C3/CPC
- Support management of patients requiring prior authorizations
- Provide insurance benefit investigation, copay assistance, foundation support, and insourcing the dispensing function of specialty medications
- Identify and qualify patients eligible for medication patient assistance programs and foundations
- Communicate with providers, patients, pharmacy, and health center teams
- Interface with drug-manufacturer reimbursement assistance program administrators
- Track, document, and report cost savings associated with patient assistance drug recovery programs
- Provide updates to pharmacy management
- Guide patients on patient assistance programs, including manufacturer coupons when available
- Follow departmental and CPC policies and procedures
- Communicate with patients in a friendly, welcoming manner
- Update demographic, insurance, and allergy information accurately
- Resolve insurance-related issues, including prior authorizations, and assist patients with financial assistance
- Remain stationary 50–75% of the time and exert up to 20 pounds of force frequently
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 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
- 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
- Employees must be vaccinated consistent with applicable law
Benefits:
- Vaccination consistent with applicable law required as an employment condition
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