5 Prior Authorization Specialist Jobs in Boston, MA
CPC-3WN is Hiring a Prior Authorization Specialist Near Boston, MA
Title: Prior Authorization Specialist
Reports to: Director, Pharmacy Operations
Classification: Individual Contributor
Location: Boston, Fenway
Job description revision number and date: V 3.0; 05.06.2024
Organization Summary:
Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable Care Organization (ACO) governed by Federally Qualified Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We are a fast-growing organization founded in 2016 with 9 health centers and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices across Massachusetts. We are an innovative organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners.
Job Summary:
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 ensuring that prior authorizations are submitted in an accurate and efficient manner, communicating with providers, patients, and health center pharmacy teams to optimize patient care.
Responsibilities:
- This position will support the management of patients requiring prior authorizations
- Providing prior authorization services, including insurance benefit investigation, copay assistance, foundation support, and insourcing the dispensing function of Specialty Medications
- Identification and qualification of patients eligible for medication patient assistance programs and foundations
- Communicates with providers, patients, pharmacy and health center teams in a professional and efficient manner
- Interfaces with program administrators for reimbursement assistance programs sponsored by the drug manufacturer
- Tracks, documents, and reports out cost savings associated with patient assistance drug recovery programs and provides updates to pharmacy management
- Provides guidance to patients on patient assistance programs (e.g. provide manufacturer coupons to patients, if available)
- Follow all applicable departmental and CPC Policies and Procedures (as they pertain to operations, quality assurance, goals and priorities)
- Customer Service- communicate 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
- Resolve insurance related issues, including prior authorizations, and assist patients with various forms of financial assistance
Physical Nature of the Job:
- Light work: Exerting up to 20 pounds of force frequently to move objects
- Must be able to remain in a stationary position 50-75% of the time
Required Skills:
- 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 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
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
** In compliance with Covid-19 Infection Control practices per Mass.gov recommendations, we require all employees to be vaccinated consistent with applicable law. **
Job Summary
Full Time
$43k-52k (estimate)
05/16/2024
07/14/2024
The job skills required for Prior Authorization Specialist include Prior Authorization, Customer Service, Primary Care, Organizational Skills, Attention to Detail, Verbal Communication, etc. Having related job skills and expertise will give you an advantage when applying to be a Prior Authorization Specialist. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Prior Authorization Specialist. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Prior Authorization Specialist positions, which can be used as a reference in future career path planning. As a Prior Authorization Specialist, it can be promoted into senior positions as an Admitting Supervisor that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Prior Authorization Specialist. You can explore the career advancement for a Prior Authorization Specialist below and select your interested title to get hiring information.
If you are interested in becoming a Prior Authorization Specialist, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a Prior Authorization Specialist for your reference.
Step 1: Understand the job description and responsibilities of an Accountant.
Quotes from people on Prior Authorization Specialist job description and responsibilities
Request, follow up and secure prior-authorizations prior to services being performed.
04/09/2022: Laramie, WY
Receive requests for pre-authorizations and ensure that they are properly and closely monitored.
03/28/2022: Schenectady, NY
Contact insurance carriers to verify patient’s insurance eligibility, benefits and requirements.
02/27/2022: Wichita, KS
Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services.
04/08/2022: Altus, OK
Reported to supervisor to assure accurate capture of services needing authorization.
02/05/2022: Dothan, AL
Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
Career tips from people on Prior Authorization Specialist jobs
Prior Authorization Specialist must have excellent computer skills including Excel, Word, and Internet use.
02/12/2022: New Britain, CT
A good Prior Authorization Specialist are those who are detail oriented with above average organizational skills.
03/28/2022: Galveston, TX
Basic understanding of human anatomy, specifically musculoskeletal would also give you benefits for this role.
04/04/2022: Lebanon, PA
Some experience in medical billing or insurance authorization are strongly preferred by most employers.
03/10/2022: Jamestown, NY
Licenses and certifications are not usually required to work as a prior authorization specialist.
04/02/2022: Mcallen, TX
Step 3: View the best colleges and universities for Prior Authorization Specialist.
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