Job details
Job type full-time
Full job description
Job id: 25816
Location: 5 branch street, methuen, ma 01844
Category: pharmacy
Employment type: full time
Work location: full remote: 4-5 days remote/wk
Overview
The pharmacy benefits specialist i, opd is responsible for completing all pharmacy prior authorizations for outpatient medicationsServes as a liaison between the multiple disease centers at dana-farber, bwh oncology patients, pharmacy, and health insurance company representativesThis role requires a detail-oriented person who can efficiently manage multiple tasks to completion.
The position is 100% remote, although the staff member may be asked to come onsite up to 1 day per week, and potentially more often during the training periodThe onsite location is currently flexible and could include methuen or boston locations.
Requirements
Process prior authorizations for all prescription medications written for all hematology and oncology patients at the dana-farber and brigham and women’s hospital by dana-farber providers.
Receive work and initiate prior authorizations upon communications from providers, pharmacy or other pharmacy benefit specialists.
Provide patient information to insurance companies as needed and in accordance with hipaa regulations as well as other state, federal and dfci/bwh guidelines.
Re-adjudicate approved claims via access to enterpriserx for prescriptions fillable in any of our outpatient pharmacies.
Communicate with pharmacists, pharmacy, prescribers, and care team, to validate information when needed and share prior authorization approval status and delay information.
When appropriate, collect and communicate co-payment information to the care team.
When appropriate, coordinate mail-order discharge meds at the brigham.
Document daily and/or update each prior authorization in a centralized tracking database and/or worksheet.
Performs related duties as assigned.
Qualifications
Minimum education:
High school or ged required.
Minimum experience:
1 year of experience in a retail pharmacy, specialty pharmacy, healthcare or health insurance environment requiredUtilization review or prior authorization experience preferred.
License/certification/registration:
Massachusetts board of pharmacy registration as pharmacy technician or intern requiredNationally certified pharmacy technician license preferred.
Knowledge, skills, and abilities required:
Demonstrates proficiency in technical skills, ability to work in various computing/information systems and microsoft office product suite.
Well organized and able to multi-task quickly and effectively.
Excellent organizational, time management and interpersonal skills.
Excellent written and verbal communication skills.
Strong team-building character and positive attitude.
Motivated, shows initiative and collaborates well in a team setting.
Ability to work as an effective member of an interdisciplinary team.
Ability to work closely and effectively with peers, coworkers, visitors, and management across the organization.
Ability to function in a busy work setting and works well in high-pressure situations.
Ability to be flexible and meet the needs of a growing department.
Ability to access dfci emr to obtain necessary information for prior authorizations, inquiries, and appeals.
