Pharmacy Services Coordinator I

Description

POSITION SUMMARY:

The Tier I Pharmacy Services Coordinator is responsible for verifying insurance benefits for oncology treatments and confirming coverage. This role includes managing patient referrals to specialists, ensuring timely processing, and maintaining accurate records in the EMR for all prior authorizations and benefit verifications. The specialist communicates with patients about their insurance status, coverage requirements, and out-of-pocket costs, while identifying cases requiring financial assistance and escalating as necessary. The position also involves supporting departmental goals by completing tasks accurately and meeting turnaround time expectations.

CORE ESSENTIAL RESPONSIBILITIES:

• Verify insurance benefits for prescribed oncology treatments to confirm coverage under the medical benefit.
• Coordinate and manage patient referrals to specialists, ensuring timely processing and communication with providers when applicable.
• Upload complete treatment documentation packets into the electronic medical record (EMR) for CCSF and TGH Revenue Cycle teams.
• Communicate with patients about insurance status, coverage requirements, and out-of-pocket costs.
• Maintain accurate, up-to-date records in the EMR for all prior authorizations and benefit verifications.
• Identify cases needing financial assistance and escalate to appropriate staff or programs as needed.
• Support departmental goals by completing assignments accurately and meeting turnaround time expectations.

Requirements

REQUIRED EDUCATION & EXPERIENCE

• High school diploma or equivalent required; associate degree in healthcare or related field preferred.
• Minimum of 2 years experience in medical insurance verification, prior authorization, or related healthcare administrative role preferred.
• Experience in oncology or infusion therapy settings is strongly preferred.

REQUIRED CERTIFICATES, LICENSE OR REGISTRATION

• None

REQUIRED KNOWLEDGE, SKILLS OR ABILITIES

• Working knowledge of insurance verification processes, medical benefits, and prior authorization workflows preferred
• Familiarity with oncology treatment terminology, infusion therapies, and related clinical documentation preferred.
• Proficiency in electronic medical records (EMR) systems and basic understanding of revenue cycle operations preferred.