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

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.

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

• 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.

Non-Bargaining Unit, 203 - HSO PHARMACY BENEFITS MANAGEMENT - MSH, Mount Sinai Hospital

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 cu