Pharmacy Access & Reimbursement Coordinator

Mount Sinai Hospital; New York (NY); On-site; USD 66,000 - 99,000; Full time

Job summary

The Mount Sinai Health System is seeking a Clinical and Financial Access Coordinator to support patients and clinical teams by obtaining prior authorizations, verifying benefits, coordinating scheduling, and assisting with Patient Assistance Programs to ensure timely medication access.

Collaborate with pharmacists and billing staff to maximize revenue capture and maintain compliance with HIPAA and regulatory requirements while supporting care plans and patient education.

Qualifications

• High School Diploma or GED required.
• Preferred: Associate degree or higher.
• Minimum 1 year of retail or specialty pharmacy technician experience preferred.
• 3 years of healthcare billing and/or managed care reimbursement or related administrative experience preferred.
• Familiarity with payer plans, PBMs, Medicare/Medicaid, and copay assistance resources.
• Pharmacy Technician registration with the New York Board of Pharmacy preferred upon hire.
• PTCB Certification required.

Responsibilities

• Receive and triage prescriptions with accurate patient and insurance information.
• Complete third-party payer prior authorization requests with medical necessity documentation.
• Resolve claim rejections and provide product overrides when necessary.
• Provide patient education and address benefit inquiries.
• Process applications for Patient Assistance Programs (PAPs) and co-pay support.
• Conduct benefit verification and pharmacy benefit checks on request.
• Coordinate patient visits with clinical pharmacists and care team.
• Obtain patient medication history.
• Assist with care plan implementation and adherence barriers.
• Refer patients to Mount Sinai-owned pharmacies.
• Maintain HIPAA, payer requirements, and Board of Pharmacy regulations.
• Provide excellent customer service via phone, email, and EHR messaging.
• Maintain detailed documentation of all activities and outcomes.
• Advanced responsibilities: supervise, mentor, and train coordinators and billing staff; oversee PA completions and reimbursement activities.

Skills

Strong communication

Organizational skills

Multitasking

Interpersonal skills

Judgment & compliance

Confidentiality

Education

High School Diploma or GED

Associate degree or higher

Pharmacy Technician registration NY preferred

PTCB Certification required

Job description

The Mount Sinai Health System is seeking a Clinical and Financial Access Coordinator to support patients and clinical teams by obtaining prior authorizations, verifying benefits, coordinating scheduling, and assisting with Patient Assistance Programs to ensure timely medication access.

Collaborate with pharmacists and billing staff to maximize revenue capture and maintain compliance with HIPAA and regulatory requirements while supporting care plans and patient education.