Patient Access & Prior Authorization Specialist

Shields Health Solutions; Boston (MA); On-site; USD 28,000 - 30,000; Full time

Benefits offered by this job

Pay transparency

Equal employment opportunities

Job summary

Shields Health Solutions is seeking a Patient Support Advocate who will help patients access medications and navigate insurance, prior authorizations, and financial assistance. You will support adherence, coordinate with foundations, and assist in pharmacy operations to improve outcomes.

The role emphasizes collaboration with physicians, pharmacists, and care teams, maintaining accurate records and delivering compassionate care. A NH regulatory credential is required where applicable.

Qualifications

• Minimum 1 year of Pharmacy Technician experience.
• Strong customer service and patient communication skills.
• Experience with insurance claims, medication access, prior authorizations, or pharmacy operations preferred.

Responsibilities

• Communicate with insurance companies to facilitate medication approvals via prior authorizations.
• Help patients access financial assistance through foundations and manufacturer programs to reduce costs.
• Navigate pharmacy systems to enter data, adjudicate claims, process refills, and create follow-up plans.
• Document patient concerns, prior authorization status, and financial needs across databases and EMR.
• Collaborate with physicians to ensure timely and appropriate medication therapy.
• Maintain complete records of patient communications and case activity.
• Assist patients in managing insurance claims and resolving coverage issues.
• Partner with pharmacists and liaisons to deliver coordinated patient care.
• Provide phone support to improve medication adherence and compliance.
• Research, investigate, and analyze information to support decision-making.
• Manage and organize data within various database applications.
• Identify trends and suggest process improvements for operational excellence.
• Protect confidential information and ensure privacy compliance.
• Stay current on industry knowledge through continuing education and networking.
• Occasional travel may be required.

Skills

Pharmacy Technician

Customer service

Patient communication

Insurance claims

Prior authorizations

Pharmacy operations

Education

High School Diploma or GED

NH State Registered or State Certified Pharmacy Technician

National certification (CPhT) preferred

Job description

Shields Health Solutions is seeking a Patient Support Advocate who will help patients access medications and navigate insurance, prior authorizations, and financial assistance. You will support adherence, coordinate with foundations, and assist in pharmacy operations to improve outcomes.

The role emphasizes collaboration with physicians, pharmacists, and care teams, maintaining accurate records and delivering compassionate care. A NH regulatory credential is required where applicable.