POSITION SUMMARY:

The Tier II Pharmacy Services Coordinator is responsible for verifying insurance benefits, obtaining pre-authorizations for oncology treatments, and calculating patient financial responsibility. The role involves coordinating referrals, communicating with patients about insurance coverage, and collaborating with clinical teams, revenue cycle, and pharmacy departments to ensure timely care and accurate documentation. The specialist also identifies cases requiring financial assistance and escalates to appropriate programs while maintaining up-to-date records in the EMR and meeting departmental goals.

REQUIRED EDUCATION & EXPERIENCE

• High school diploma or equivalent required; associate degree in healthcare, pharmacy, or related field preferred.
• Minimum 3 years of experience in medical benefit verification, oncology authorizations, or specialty pharmacy coordination preferred.
• Experience working with EMR systems (e.g., Epic) and insurance portals; knowledge of chemotherapy regimens and oncology billing practices preferred.

REQUIRED KNOWLEDGE, SKILLS OR ABILITIES

• At least one year of experience as a Tier I Pharmacy Services Coordinator, or the ability to perform all core essential functions of a Tier I Pharmacy Services Coordinator.
• Strong understanding of medical benefit structures, insurance authorization workflows, and payer-specific requirements for oncology treatments preferred
• Familiarity with chemotherapy protocols, drug administration routes (oral, IV), and related terminology to support treatment assessments and billing accuracy preferred.
• Proficiency in using electronic medical records (EMR), insurance verification tools, and communication with third-party payers and clinical teams preferred.

• 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.
• Obtain and document initial and ongoing pre-authorizations for all services, including some chemotherapy, immunotherapy, and supportive IV therapies.
• 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.
• Calculate and communicate accurate patient financial responsibility using payer benefits, cost-share information, and applicable assistance programs.
• Answer calls from patients and insurance companies regarding the authorization and financial clearance process.
• Coordinate with providers and clinical teams to resolve missing or incomplete treatment documentation.
• Maintain accurate, up-to-date records in the EMR for all prior authorizations and benefit verifications.
• Collaborate closely with providers, revenue cycle, and pharmacy teams to ensure timely prior authorization approvals and prevent delays in care.
• Identify cases needing financial assistance and escalate to appropriate staff or programs.
• Support departmental goals by completing assignments accurately and meeting turnaround time expectations.
  Requirements: