Specialty Pharmacy Financial Access Coordinator, Lead; PHARMACY BENEFITS MANAGEMENT; Full Time; Days

Pharmacy Access Coordinator Lead

Ground breaking science. Advancing medicine. Healing made personal.

Roles & Responsibilities:

Under direct supervision of the Director of Pharmacy, the Pharmacy Manager and the Pharmacy Clinical Liaison, the Pharmacy Access Coordinator Lead supervises Financial Access Coordinator staff and interacts with clinical employees on multiple levels, including pharmacists, nurses, medical/clinical staff, Finance personnel, department managers, access services staff, and Billing Assistants. External contacts may include third party payers, accrediting bodies, external partners, insurance/PBM companies, government peer review organizations, accrediting bodies and referring physicians. The relationships are inherent to the success of this position. The Lead is primarily responsible for, but not limited to, oversight of staff responsible for the prompt attention to prior authorization of specialty medications, oversight of quality of work done in key department systems, support of medical staff, assistance in obtaining financial support for patients, and timely communication with medical providers, including mail correspondence, messaging, telephone correspondence and EHR documentation.

Duties and Responsibilities:

1. Organizes the duties of subordinate technical and clerical personnel, including less experienced Specialty Financial Pharmacy Access Coordinators, and billers.
2. Maintains thorough documentation on all authorization requests, prescription verifications and other data by facility.
3. Supports supervising Pharmacists.
4. Supports manages and directors in the training and mentoring of new pharmacy personnel; nurtures a teamwork environment.
5. Periodically meets with and manages vendors and pharmaceutical manufacturers.
6. Organizes and presents reports and analytics as requested.
7. Reviews and evaluates outpatient take-home prescriptions and determines feasibility of processing through patient and payer-preferred specialty pharmacy and, if not, coordinates service with the correct pharmacy group.
8. Obtains prior authorizations from intermediaries and payers, including managed care companies, insurance companies or others as appropriate. Ensures completion of activities that maximize revenue capture for high-cost medications.
9. Facilitates a high level of customer service by the completion of applications, including those for the Patient Assistance Program (PAP) and co-pay assistance.
10. Interacts with medical and professional staff on a case by case basis to obtain appropriate clinical documentation to ensure accurate indications in the patient's medical record before completion of third party authorization.
11. Communicates with appropriate individuals (i.e., patient, providers, and pharmacy staff) regarding outcomes of prior authorizations and responds to complex questions from third party payers and clinical staff regarding medication-related issues.
12. Adjudicates approved prescriptions through the pharmacy software system or begins the appeal process for denied prescriptions.
13. Processes PAP (Patient Assistance Program) requests. Documents actions taken, runs weekly reports, keeps open lines of communication by facilitating between pharmacy, other healthcare professions, the patient, manufacturers and payers.
14. Runs Pharmacy benefit checks at the providers' requests; periodically performs software tests for proper functionality to ensure coverage for specific medications.
15. Supports, facilitates and reviews departmental projects, initiatives and partner programs.
16. Works with department pharmacists and administrators to design, administer and support quality assurance and related tasks.
17. Accesses and reviews work performed in all key department systems (dispense, clinical management, EMR)
18. Additional duties as assigned.

Requirements:

Education:

Associates degree (Bachelor's degree preferred)

PTCB certification required

Experience:

3+ years of retail pharmacy technician experience or related health care administrative, and a strong familiarity with the prior authorization process preferred. Working knowledge of third party payer plans and how they are processed, of medication reimbursement, including the prior authorization process, proficiency in the procurement of financial assistance for patients with government-sponsored health plans including Medicare, Medicaid and TriCare.

Preferred:

3 years of health care related billing and benefits investigation

1 year of retail pharmacy experience

1 year of PBM payer operations

1 year of hospital/institutional pharmacy

Strength Through Diversity

The Mount Sinai Health System believes that diversity and inclusion is a driver for excellence. We share a common devotion to delivering exceptional patient care. Yet we're as diverse as the city we call home- culturally, ethically, in outlook and lifestyle. When you join us, you become a part of Mount Sinai's unrivaled record of achievement, education and advancement as we revolutionize healthcare delivery together.

We work hard to recruit and retain the best people, and to create a welcoming, nurturing work environment where you have the opportunity and support to develop professionally. We share the belief that all employees, regardless of job title or expertise, have an impact on quality patient care.

Explore more about this opportunity and how you can help us write a new chapter in our story!

Who We Are

Over 38,000 employees strong, the mission of the Mount Sinai Health System is to provide compassionate patient care with seamless coordination and to advance medicine through unrivaled education, research, and outreach in the many diverse communities we serve.

Formed in September 2013, The Mount Sinai Health System combines the excellence of the Icahn School of Medicine at Mount Sinai with seven premier hospitals, including Mount Sinai Beth Israel, Mount Sinai Brooklyn, The Mount Sinai Hospital, Mount Sinai Queens, Mount Sinai West (formerly Mount Sinai Roosevelt), Mount Sinai Morningside (Formerly St Luke's), and New York Eye and Ear Infirmary of Mount Sinai.

The Mount Sinai Health System is an equal opportunity employer. We comply with applicable Federal civil rights laws and does not discriminate, exclude, or treat people differently on the basis of race, color, national origin, age, religion, disability, sex, sexual orientation, gender identity, or gender expression.

EOE Minorities/Women/Disabled/Veterans

Compensation

The Mount Sinai Health System (MSHS) provides a salary range to comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $0.00 - $0.00 Annually. Actual salaries depend on a variety of factors, including experience, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.