Prior Authorization Specialist

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🔥 10 minutes ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $33 - $38 / hour

⏰ Full Time

🟢 Junior

👻 Ghost score 0%

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Community Care Cooperative (C3)

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2016

🏥 Healthcare

🤝 Non-profit

🌍 Social Impact

Healthcare • Non-profit • Social Impact

Community Care Cooperative (C3) is a rapidly growing non-profit created by Federally Qualified Health Centers (FQHCs) to strengthen primary care, improve financial performance, and advance racial justice. C3 unites health centers into FQHC-led accountable care networks, providing contracting, data, actuarial, and population-health capabilities to enable participation in value-based payment and care models. It also operates affiliates that deliver technology services (Community Technology Cooperative), pharmacy operations and 340B support (Community Pharmacy Cooperative), and a statewide telehealth consortium to help health centers integrate telehealth into primary and behavioral care.

📋 Description

• Process and submit prior authorizations on behalf of FQHCs working with C3/CPC • Support management of patients requiring prior authorizations • Provide insurance benefit investigation, copay assistance, foundation support, and insourcing the dispensing function of specialty medications • Identify and qualify patients eligible for medication patient assistance programs and foundations • Communicate with providers, patients, pharmacy, and health center teams • Interface with drug-manufacturer reimbursement assistance program administrators • Track, document, and report cost savings associated with patient assistance drug recovery programs • Provide updates to pharmacy management • Guide patients on patient assistance programs, including manufacturer coupons when available • Follow departmental and CPC policies and procedures • Communicate with patients in a friendly, welcoming manner • Update demographic, insurance, and allergy information accurately • Resolve insurance-related issues, including prior authorizations, and assist patients with financial assistance • Remain stationary 50–75% of the time and exert up to 20 pounds of force frequently

🎯 Requirements

• Expertise in prior authorization submission to PBMs • Ability to manage processes and develop implementation strategies • Previous experience in a pharmacy, retail, medical, or customer service setting • Familiarity with Microsoft Word and Excel • Strong analytical and organizational skills, including ability to analyze data to identify trends and communicate them through effective reporting methods • Strong attention to detail • Excellent oral, written, and verbal communication skills, including experience presenting complex information to senior leaders • Skilled in exercising a high degree of initiative, judgement, discretion, and decision making to achieve objectives • Current licensure in Commonwealth of Massachusetts as a pharmacy technician • 1 year experience in submitting prior authorizations on behalf of a medical center • GED or High School diploma required • Employees must be vaccinated consistent with applicable law

🏖️ Benefits

• Vaccination consistent with applicable law required as an employment condition

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