Pharmacy Clinical and Financial Access Coordinator; HSO Pharmacy Benefits Management; Full Time; Days; Hybrid

Clinical and Financial Access Coordinator

Under the direction of the Director of Pharmacy and Pharmacy leadership, the Clinical and Financial Access Coordinator supports patients and clinical teams by facilitating access to medications through insurance prior authorizations, benefits investigations, scheduling coordination, care plan implementation, and financial assistance programs. The role interacts with pharmacists, medical and clinical staff, finance and billing personnel, and third-party payers to ensure timely medication access and accurate reimbursement.

Responsibilities

1. Receive and triage prescriptions, ensuring accurate patient and insurance information. 2. Complete third-party payer prior authorization requests, including medical necessity documentation and follow-up with providers and insurers. 3. Resolve claim rejections and provide product overrides when necessary. 4. Provide patient education and address benefit inquiries as necessary. 5. Process and document applications for Patient Assistance Programs (PAPs) and co-pay support. 6. Conduct benefit verification and pharmacy benefit checks at provider request. 7. Coordinate patient visits with clinical pharmacists and care team. 8. Obtain the patient's medication history. 9. Assist with care plan implementation and resolution of medication adherence barriers. 10. Refer patients via telephonic encounters to fill medications at Mount Sinai-owned pharmacies. 11. Maintain compliance with HIPAA, payer requirements, and Board of Pharmacy regulations. 12. Provide exceptional customer service through phone, email, and EHR messaging with patients and healthcare teams. 13. Maintain detailed documentation of all activities and outcomes. 14. Advanced / Lead Responsibilities (as assigned): 15. Supervise, mentor, and train Clinical and Financial Access Coordinators and billing staff; promote teamwork and accountability. 16. Oversee completion and quality of prior authorizations and reimbursement activities to maximize revenue capture for high-cost medications. 17. Review outpatient prescriptions for payer routing and specialty network requirements; coordinate with appropriate pharmacy entities. 18. Prepare reports and analytics on workflow performance, prior authorization turnaround, and PAP utilization. 19. Serve as a liaison to pharmaceutical manufacturers, vendors, and accrediting bodies. 20. Participate in audits, accreditation reviews, and quality assurance initiatives. 21. Escalate complex payer or coverage issues and assist with appeals. 22. Support with Open Enrollment activities as necessary 23. Support special projects and process improvement initiatives. 24. Perform other related duties as assigned.

General Skills and Competencies

25. Strong oral and written communication skills 26. Excellent organizational skills and attention to detail 27. Ability to multitask in a fast-paced environment 28. Effective interpersonal skills with internal and external stakeholders 29. Sound judgment and ability to follow established protocols 30. Commitment to high standards of patient confidentiality and customer service

Qualifications

• Required: High School Diploma or GED
• Preferred: Associate degree or higher
• Minimum 1 year of retail or specialty pharmacy technician experience preferred
• 3 years of healthcare billing and/or managed care reimbursement, or related administrative experience preferred
• Familiarity with payer plans, PBMs, Medicare/Medicaid, and copay assistance resources
• Pharmacy Technician registration with the New York Board of Pharmacy preferred upon hire
• PTCB Certification required

Compensation Statement

The Mount Sinai Health System (MSHS) provides salary ranges that comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $65,885.00 - $98,827.00 Annually. Actual salaries depend on a variety of factors, including experience, education, and operational need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.

About Us

Strength through Unity and Inclusion

The Mount Sinai Health System is committed to fostering an environment where everyone can contribute to excellence. We share a common dedication to delivering outstanding patient care. When you join us, you become part of Mount Sinai's unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. We encourage all team members to actively participate in creating a culture that ensures fair access to opportunities, promotes inclusive practices, and supports the success of every individual.

At Mount Sinai, our leaders are committed to fostering a workplace where all employees feel valued, respected, and empowered to grow. We strive to create an environment where collaboration, fairness, and continuous learning drive positive change, improving the well-being of our staff, patients, and organization. Our leaders are expected to challenge outdated practices, promote a culture of respect, and work toward meaningful improvements that enhance patient care and workplace experiences. We are dedicated to building a supportive and welcoming environment where everyone has the opportunity to thrive and advance professionally. Explore this opportunity and be part of the next chapter in our history.

About the Mount Sinai Health System:

Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients' medical and emotional needs at the center of all treatment. The Health System includes more than 9,000 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report's "The World's Best Smart Hospitals" ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.

Equal Opportunity Employer

The Mount Sinai Health System is an equal opportunity employer, complying with all applicable federal civil rights laws. We do not discriminate, exclude, or treat individuals differently based on race, color, national origin, age, religion, disability, sex, sexual orientation, gender, veteran status, or any other characteristic protected by law. We are deeply committed to fostering an environment where all faculty, staff, students, trainees, patients, visitors, and the communities we serve feel respected and supported. Our goal is to create a healthcare and learning institution that actively works to remove barriers, address challenges, and promote fairness in all aspects of our organization.

Job Info

• Job Identification 3039475
• Job Category Professional
• Locations 150 E 42nd St, New York, NY, 10017, US