Mount Sinai Morningside · 1 week ago
Employee Benefits Pharmacy Financial Access Coordinator, Lead; Mount Sinai Health System; Full Time; Days
New York, NY
Full-time
Onsite
Mid, Senior Level
$60K/yr - $78K/yr
3+ years expMount Sinai Health System is one of the largest academic medical systems in the New York metro area, and they are seeking a Lead Employee Benefits Pharmacy Financial Access Coordinator. The role involves supervising Financial Access Coordinator staff, overseeing prior authorization processes for specialty medications, and ensuring quality communication with medical providers and patients.
Hospital & Health Care
Responsibilities
Organizes the duties of subordinate technical and clerical personnel, including less experienced Specialty Financial Pharmacy Access Coordinators, and billers
Maintains thorough documentation on all authorization requests, prescription verifications and other data by facility
Supports supervising Pharmacists
Supports managers and directors in the training and mentoring of new pharmacy personnel; nurtures a teamwork environment
Periodically meets with and manages vendors and pharmaceutical manufacturers
Supports, facilitates, and reviews departmental projects, initiatives, and partner programs
Works with department pharmacists and administrators to design, administer, and support quality assurance and related tasks
Accesses and reviews work in all key department systems (dispense, clinical management, EMR)
Organizes and presents reports and analytics as requested
Reviews and evaluates outpatient take-home prescriptions and determines feasibility of processing through patient and payer-preferred specialty pharmacy and, if not, coordinates service with the correct pharmacy group
Obtains prior authorizations from intermediaries and payers, including managed care companies, insurance companies or others as appropriate. Ensures completion of activities that maximize revenue capture for high-cost medications
Facilitates a high level of customer service by the completion of applications, including those for the Patient Assistance Program (PAP) and co-pay assistance
Interacts with medical and professional staff on a case by case basis to obtain appropriate clinical documentation to ensure accurate indications in the patient’s medical record before completion of third party authorization. This may include contacting referring physicians for information
Communicates with appropriate individuals (i.e., patient, providers, and pharmacy staff) regarding outcomes of prior authorizations and responds to complex questions from third party payers and clinical staff regarding medication-related issues and reimbursement
Adjudicates approved prescriptions through the pharmacy software system or begins the appeal process for denied prescriptions
Processes PAP (Patient Assistance Program) requests. Documents actions taken, runs weekly reports, keeps open lines of communication by facilitating between pharmacy, other healthcare professions, the patient, medication manufacturers and third party payers
Runs Pharmacy benefit checks at the providers’ requests; periodically performs software tests for proper functionality to ensure coverage for specific medications
Maintains compliance with all pertinent regulations and laws (HIPAA, Board of Pharmacy, etc)
Other duties as assigned
Qualification
Required
Associates degree (Bachelor's degree preferred)
3+ years of retail pharmacy technician experience or related health care administrative experience
Strong familiarity with the prior authorization process
Working knowledge of third party payer plans and how they are processed
Knowledge of medication reimbursement, including the prior authorization process
Proficiency in the procurement of financial assistance for patients with government-sponsored health plans including Medicare, Medicaid and TriCare
Preferred
3 years of health care related billing and benefits investigation
1 year of retail pharmacy experience
1 year of PBM payer operations
1 year of hospital/institutional pharmacy
Company
Mount Sinai Morningside
At Mount Sinai Morningside, we offer exceptional clinical care and research within the comfort of a neighborhood hospital known for compassion and sensitivity.
1001-5000 employees
H1B Sponsorship
Mount Sinai Morningside has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (5)
2024 (3)
2023 (26)
2022 (20)
2021 (6)
2020 (20)
Funding
Current Stage
Late StageLeadership Team
Faye Reiff-Pasarew
Deputy CMO, Associate Chief of Hospital Medicine, Assistant Professor of Internal Medicine
Lucy Xenophon, MD, MPH
Chief Transformation Officer
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