Remote Prior Authorization Specialist - Pharmacy Operations

Community Care Cooperative (C3); New York (NY); Teletrabalho; USD 55 000 - 75 000; Tempo integral

Resumo da oferta

Community Care Cooperative (C3) seeks a Prior Authorization Specialist to process and submit prior authorizations for FQHCs through CPC/C3. The role supports ACO activities and patient care by ensuring timely, accurate authorizations and communicating with providers, patients, and pharmacy teams.

The incumbent will manage benefit investigations, copay support, and patient assistance programs, while upholding CPC policies and delivering professional service.

Qualificações

• MA Pharmacy Technician license required.
• Minimum 1 year submitting prior authorizations for a medical center.
• Experience in pharmacy, retail, medical, or customer service preferred.
• Proficient with MS Word and Excel; strong data handling abilities.
• Ability to analyze data, identify trends and report findings clearly.
• Excellent attention to detail and accuracy in all tasks.
• Strong written and verbal communication; professional interaction with leaders.
• Shows initiative, judgment, and discretion to meet objectives.

Responsabilidades

• Process and submit prior authorizations for FQHCs via CPC/C3.
• Provide insurance benefit research, copay support, and program assistance.
• Identify patients eligible for patient assistance programs and foundations.
• Communicate with providers, patients, and pharmacy teams professionally.
• Support reimbursement programs sponsored by drug manufacturers.
• Track and report cost savings from patient assistance programs to management.
• Guide patients on patient assistance programs when available.
• Follow CPC/C3 policies and procedures and ensure quality assurance.
• Deliver friendly customer service and maintain accurate demographic data.
• Resolve insurance issues and assist with financial aid applications.

Conhecimentos

Prior authorization submission to PBMs

Process management

Pharmacy/retail/customer service

Microsoft Word & Excel

Analytical reporting

Attention to detail

Communication skills

Initiative and judgment

Formação académica

Massachusetts Pharmacy Technician licensure

1 year prior authorizations experience

GED or High School diploma

Descrição da oferta de emprego

Community Care Cooperative (C3) seeks a Prior Authorization Specialist to process and submit prior authorizations for FQHCs through CPC/C3. The role supports ACO activities and patient care by ensuring timely, accurate authorizations and communicating with providers, patients, and pharmacy teams.

The incumbent will manage benefit investigations, copay support, and patient assistance programs, while upholding CPC policies and delivering professional service.