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Details
Posted: 17-Apr-25
Location: Boston, Massachusetts
Internal Number: 147126667
General Summary
The PA Coordinator and Pharmacy Technician work in conjunction with clinical teams, patients, and caregivers to facilitate medication and medication-related equipment insurance prior authorizations. They provide accurate and timely non-clinical administrative support, and coordinates all phases of the PA process with the insurance companies, engaging clinical pharmacist and prescriber support as needed.
Duties and Responsibilities:
The PA Coordinator and Pharmacy Technician work in conjunction with clinical teams, patients, and caregivers to facilitate medication and medication-related equipment insurance prior authorizations. They provide accurate and timely non-clinical administrative support, and coordinates all phases of the PA process with the insurance companies, engaging clinical pharmacist and prescriber support as needed.
Duties and Responsibilities:
- Communicates directly with insurance companies to obtain prior authorization approvals for medications and medication-related equipment.
- Assists clinical team in coordinating pursuing denial/appeal process if needed.
- Plans and prioritizes the coordination and tracking of the prior authorization renewal process.
- Coordinates medication prescription requests including but not limited to prior authorizations, verbal overrides, setting up specialty pharmacy accounts, verifying copays and exploring assistance options, referring to Social Work or the Medication Discharge Financial Assistance program as needed
- Navigates pharmacy operating systems to enter data, perform adjudication on test claims, and prepare action plans for follow-up.
- Documents information related to patient concerns, prior authorization status, and financial assistance needs in the electronic medical record and other systems as instructed.
- Reviews prescriptions to ensure optimal care of the patient relays concerns to prescribers.
- Maintains complete and accurate records of patient communications.
- Assists patients and caregivers in navigating pharmacy insurance claims.
- Communicates directly with patients and caregivers as needed to assist with insurance company requirements, such as submitting consent for shipments.
- Works closely with pharmacists and pharmacy liaisons to provide an integrated approach to quality patient care.
- Researches and investigates alternative options as needed.
- Manages, organizes, and updates relevant data using database applications.
- High School Diploma, Associates preferred
- MA licensed Pharmacy Technician
- Minimum of 1 year experience in prior authorization management in a healthcare setting
Boston Children's Hospital offers competitive compensation and unmatched benefits including flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork
About Boston Children's Hospital
Boston Children's Hospital is a 395-bed comprehensive center for pediatric health care. As one of the largest pediatric medical centers in the United States, Children's offers a complete range of health care services for children from birth through 21 years of age.
More Jobs from This Employer
https://careers.pharmtechsociety.org/jobs/21251213/prior-auth-coordinator-pharmacy-technician
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