State Operations Coverage Specialist

🔥 10 hours ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $62k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

⚙️ Operations

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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Patient Funding Alternatives

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Patient Funding Alternatives is a company that helps medically underserved Medicaid populations gain access to employer-sponsored commercial insurance through state premium assistance programs. It specializes in Premium Assistance Enrollment and assigns Patient Advocate Specialists who work with hospitals’ financial counselors, social workers and case managers to streamline enrollment, reduce administrative burden, and support patients from the initial episode of care through ongoing services. PFA positions itself around health equity and patient advocacy, partnering with hospitals, health systems, states and employers to enroll eligible patients and manage much of the administrative work on the hospital’s behalf.

📋 Description

• Confirm that all services, providers, and medications are in network with both Employer-Sponsored Insurance (ESI) and Fee-for-Service (FFS) Medicaid • Resolve coordination of benefits issues • Help families obtain prior authorizations as needed • Resolve pharmacy issues and help families obtain medications as needed • Participate in team meetings and complete follow-ups • Perform other duties as needed • Support day-to-day operational work for PFA's Pennsylvania team

🎯 Requirements

• High school diploma or GED • Completion of formal training or coursework in healthcare administration, patient services, or a similar field • At least 2 years of experience in insurance verification, prior authorization, Medicaid or managed care, pharmacy benefits, or revenue cycle • Ability to read and analyze drug formularies and Summary of Benefits documents • Excellent verbal and written communication skills • Effective time management and organizational skills • Attention to detail • Creative problem-solving skills • Preferred: Bachelor's degree in healthcare administration, patient services, or a related field • Preferred: 3 to 5 years of relevant experience, ideally with Pennsylvania Medicaid or the PA HIPP program • Preferred: Extensive knowledge of Pennsylvania Managed Care Medicaid, Medical Assistance, and the PA HIPP program • Preferred: Extensive knowledge of obtaining prior authorizations

🏖️ Benefits

• Employer-subsidized medical coverage • Supplemental cost-offset benefit to help reduce out-of-pocket expenses at the point of care • Dental coverage • Vision coverage • Company-paid life insurance effective day one • Company-paid disability insurance effective day one • 401(k) retirement program with up to a $2,000 annual match • Flexible spending accounts • Employee Assistance Program • Wellness benefit • Benefits supporting eligible dependents • Remote work availability

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