The Pharmacy Benefits Specialist II, OPD is responsible for completing all pharmacy prior authorizations for outpatient medications. Serves as a liaison between the multiple disease centers at Dana-Farber, BWH oncology patients, pharmacy, and health insurance company representatives. This role requires a detail-oriented person who can efficiently manage multiple tasks to completion. Additionally, the Pharmacy Benefits Specialist II, OPD will assist with the Celgene REMS program authorizations and provide support to level I team members as needed.
Located in Boston and the surrounding communities, Dana-Farber Cancer Institute is a leader in life changing breakthroughs in cancer research and patient care. We are united in our mission of conquering cancer, HIV/AIDS, and related diseases. We strive to create an inclusive, diverse, and equitable environment where we provide compassionate and comprehensive care to patients of all backgrounds, and design programs to promote public health particularly among high-risk and underserved populations. We conduct groundbreaking research that advances treatment, we educate tomorrow's physician/researchers, and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.
PRIMARY DUTIES AND RESPONSIBILITIES:
- 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.
- Support DFCI prescribers of Celgene products with REMS program patient registration, authorization numbers, and refill tracking as needed.
- Responsible for triaging work as needed to Pharmacy Benefit Specialist I staff members.
- Assist with the re-balancing of workload assignments, as coordinated by the manager, to help cover PTO and other time off requests.
- Performs related duties as assigned.
KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:
- Demonstrates proficiency in technical skills, ability to work in various computing/information systems and Microsoft Office product suite.
- Knowledge of basic retail pharmacy claims adjudication processes.
- Knowledge of hospital EMR functionality, including patient charts and in-basket messaging.
- 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.
SUPERVISORY RESPONSIBILITIES: None
PATIENT CONTACT: None
MINIMUM JOB QUALIFICATIONS:
Minimum Education:
High School or GED required.
Minimum Experience:
3 years of experience in a retail pharmacy, specialty pharmacy, healthcare, or health insurance environment with focus on, or significant exposure to, prior authorization work required. 6 years of dispensing in an oncology focused retail or outpatient pharmacy would be equivalent to 3 years of prior authorization work.
License/Certification/Registration:
Massachusetts Board of Pharmacy Registration as Pharmacy Technician or Intern required. Nationally Certified Pharmacy Technician license required, with the exception of pharmacy students.
At Dana-Farber Cancer Institute, we work every day to create an innovative, caring, and inclusive environment where every patient, family, and staff member feels they belong. As relentless as we are in our mission to reduce the burden of cancer for all, we are committed to having faculty and staff who offer multifaceted experiences. Cancer knows no boundaries and when it comes to hiring the most dedicated and compassionate professionals, neither do we. If working in this kind of organization inspires you, we encourage you to apply.
Dana-Farber Cancer Institute is an equal opportunity employer and affirms the right of every qualified applicant to receive consideration for employment without regard to race, color, religion, sex, gender identity or expression, national origin, sexual orientation, genetic information, disability, age, ancestry, military service, protected veteran status, or other characteristics protected by law.
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Pay Transparency Statement
The hiring range is based on market pay structures, with individual salaries determined by factors such as business needs, market conditions, internal equity, and based on the candidate’s relevant experience, skills and qualifications.
For union positions, the pay range is determined by the Collective Bargaining Agreement (CBA).
$66,331.20 - $76,440.00
