Pharmacy Care Coordinator - Remote in Massachusetts

Explore opportunities at Atrius Health, part of the Optum family of businesses. We're an innovative health care leader and multi-specialty group practice, delivering an effective, connected system of care for adult and pediatric patients at 28 practice locations in eastern Massachusetts. Our entire team of providers (physicians, AP/NPs and ancillary clinicians) works collaboratively with a value-based philosophy within our group practice as well as with hospitals, rehab and nursing facilities. Be part of our vision to transform care and improve lives by building trust, understanding and shared decision-making with every patient. Join us and discover the meaning behind Caring. Connecting. Growing together. Responsible for navigating requests for the prior authorization of medications not covered by a patient's insurance in accordance with insurance provider guidelines. Serves as an expert on subject matters for medication prior authorizations and maintains a solid understanding of healthcare insurance policies, drug information, pharmacy benefit management, and medical terminology. Schedule: Monday - Friday, 8:30am - 5:00pm Location: This role is Remote in Massachusetts. If you reside in Massachusetts, you will have the flexibility to work remotely as you take on some tough challenges.

Responsible for communicating directly with patients, insurance companies, providers, clinical pharmacists and pharmacies to support timely review and processing of prior authorization requests for new and refill prescriptions Acquires and maintains a working knowledge of health plan formulary and authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization Develops proficiencies in utilization of Epic in accordance with department standard work guidelines Verifies patient's demographics, insurance eligibility and prescription benefit information required to process new and refill prescriptions, where permitted by state law Gathers all necessary information from chart review and identifies correct forms needed to submit prior authorization request to insurance providers Works as a patient advocate and functions as a liaison between the patient and payer to answer routine and complex inquiries, reimbursement questions, and avoid insurance delays Communicates with providers and patients to provide updates on the status of their prior authorizations or appeals Provides prompt feedback to physicians and management regarding issues with medication authorization denials and health plan recommendations and or alternatives when provided by the insurance company Assists patients with financial assistance for high copay medication utilizing manufacturer coupons, manufacturer patient assistance programs or provides patient with the appropriate Med Cost Savings Form and collaborates with Clinical Pharmacists as necessary Acquires and maintains a working knowledge of drug manufacturer patient assistance programs to include drug manufacturer coupons/vouchers and has knowledge of how to access them Ability to perform all tasks of a pharmacy care coordinator and other similar and related duties to assist with staff cross coverage as required or directed by the supervisor Provides superior phone services and quality customer service to ensure the highest level of patient satisfaction Interacts effectively and professionally with all patients, prescribers, payors, pharmacies and all location departments of Atrius Health Ability to work quickly and accurately on an independent basis with great attention to detail, and displaying initiative to quickly identify and resolve variances and discrepancies Follows all professional and departmental guidelines for PHI and HIPPA compliance and with all relevant laws, regulations, and policies related to medication prior authorizations Actively contributes to the evaluation and continuous improvement of the prior authorization process as well as