- Secondary Responsibilities
- Patient Coordination & Assistance
- Conduct one-on-one meetings with patients to explain insurance benefits, out-of-pocket costs, and available financial support options.
- Complete, submit, and track applications for Patient Assistance Programs (PAP), foundation grants, and co-pay cards on behalf of eligible patients.
- Guide patients through the access journey, clearly communicating the documentation required for medication and equipment approvals.
- Prior Authorizations & Coverage Guidance
- Processing and submitting prior authorizations, maintaining a high level of expertise in clinical criteria.
- Investigate, draft, and respond to detailed daily inquiries from providers regarding insurance coverage guidelines, clinical criteria requirements, and denial management strategies.
- Act as the primary escalation point for complex coverage issues, collaborating with clinical staff to formulate and submit successful appeals for denied therapies.
Qualifications
Education
High School Diploma or Equivalent required
Can this role accept experience in lieu of a degree?
No
Experience
Previous pharmacy technician experience in a hospital, retail, specialty, ambulatory pharmacy
Experience with prior authorizations, insurance billing, rejected claims, medication access, patient-assistance programs, or specialty medications
Experience using electronic medical records, pharmacy systems, insurance portals, and Microsoft Outlook
Pharmacy Technician registration, license, or national certification, such as PTCB CPhT or NHA ExCPT preferred but not required
Knowledge, Skills and Abilities
Knowledge of laws and regulations related to clinical practice and patient confidentiality.
Knowledge of medication abbreviation and symbols, medication indication and dosage, and common medication questions.
Strong written and verbal communication skills.
Demonstrated skills in service excellence including active listening, problem solving and ability to remain calm in emotional situations.
Additional Job Details (if applicable)
Remote Type
Hybrid
Work Location
75 Francis Street
Scheduled Weekly Hours
40
Employee Type
Regular
Work Shift
Day (United States of America)
Pay Range
$22.81 - $27.71/Hourly
At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.
EEO Statement
2200 The Brigham and Women's Hospital, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.
Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
