Massachusetts Healthcare Jobs

Job Type: Regular

Time Type: Full time

Work Shift: Day (United States of America)

FLSA Status: Non-Exempt

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

Specialty Pharmacy Liaison

Job Description:

Job Summary: This position acts as a liaison between the specialty/retail pharmacy and the prescribers to document, submit, communicate outcomes and appeal if necessary all pharmacy/medical prior authorizations. Is also involved in all aspects of obtaining patient access to prescribed medication.

Essential Responsibilities:

1. Understands product and payer reimbursement landscape and prior authorization guidelines and processes.

2. Collects and reviews all data needed pharmacy and/or medical for prior authorization approvals.

3. Resolves insurance related issues, including prior authorizations (PAs), and assist patients with various forms of financial assistance.

4. Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly; maintains frequent phone contact with patient, provider and pharmacy staff; and clarifies prescription orders with pharmacist and/or clinician as appropriate.

5. Serves as the direct patient and provider contact for pharmacy benefit information, clinical and program information.

6. Coordinates services with providers, specialty pharmacies and national account managers to improve turnaround time for patients.

7. Communicates directly with patients to assist them in the awareness of their medications and coordinate teaching visits.

8. Manage multiple strategic initiatives simultaneously and reprioritize where necessary and independently and effectively resolves complex accounts, and determine methods and procedures on new or special assignments with minimal supervision.

9. Networks with key contacts inside and outside own area of expertise.

10. Provides training and support to inter-departmental associates.

Required Qualifications:

1. High School diploma or GED required.

2. License Mass Registered Pharmacy Tech preferred., or Registration Pharm Tech Cert Board preferred.

3. 1-3 years related work experience required in prior authorization.

4. Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.

Preferred Qualifications:

1. PTCB certification

2. Specialty Pharmacy experience and/or prior authorization experience.

3. Knowledge of medication use in RA, GI, transplant, hepatitis C, infectious disease (including HIV), and/or oncology a plus.

Competencies:

1. Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.

2. Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.

3. Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.

4. Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.

5. Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.

6. Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.

7. Team Work: Ability to act as a team leader for small projects or work groups, creating a collaborative and respectful team environment and improving workflows. Results may impact the operations of one or more departments.

8. Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations.

Physical Nature of the Job:

Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more (https://www.bilh.org/newsroom/bilh-to-require-covid-19-influenza-vaccines-for-all-clinicians-staff-by-oct-31) about this requirement.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled