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Job Description

The World Trade Center Mental Health (MH) Pharmacy Benefits Coordinator plays a crucial role in coordinating pharmacy benefits for WTC members who receive care at the WTC MH Program. MH Pharmacy Benefits Coordinator interacts with the WTCHP Pharmacy team, patients, hospital employees, specialty pharmacy staff, medical/clinical staff, department managers, and clinics. External contacts include insurance companies on behalf of patient's medical and pharmacy benefits, pharmacies, and providers. These activities include supporting and interacting with patients, coordinating their prescriptions, and working with clinical staff to complete prior authorization requests (when applicable). The World Trade Center Mental Health (MH) Pharmacy Benefits Coordinator reports to WTC MH Program Manager.

Qualifications

+ **Education Requirements** Associates degree (Bachelor’s degree preferred)

+ 3+ years of retail pharmacy technician experience or related health care administrative, and a strong familiarity with the prior authorization process preferred. Working knowledge of third party payer plans and how they are processed, 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

Responsibilities

+ Works closely with the WTCHP Pharmacy team to ensure patients achieve access to medications

+ Assists in the operational workflows including product overrides, prior authorizations, patient navigation, and scheduling as required for referred patients

+ Aids in quality assurance process on WTCHP pharmacy claims

+ Assists in answering pharmacy benefit questions.

+ Provides a high level of customer service by triaging medication access questions including medication rejections at point of sale

+ Escalates patient and provider concerns in a timely manner

+ Schedules appointments, monitors follow-ups and addresses no-shows

+ Ability to work collaboratively as a member of an interdisciplinary team and establish and maintain effective working relationships with other healthcare professionals, practitioners, patients and families.

+ Makes recommendations on system improvements to streamline clinical review processes, participates in the implementation of such optimizations and takes a leading role in staff retraining, when applicable

+ Provides education on Program guidelines and coverage determination to interdisciplinary teams.

+ Other duties as assigned Requirements:

About Us

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 culture that ensures fair access to opportunities, promotes inclusive practices, and supports the success of every individual.

At Mount Sinai, our leaders are committed to fostering a workplace where all employees feel valued, respected, and empowered to grow. We strive to create an environment where collaboration, fairness, and continuous learning drive positive change, improving the well-being of our staff, patients, and organization. Our leaders are expected to challenge outdated practices, promote a culture of respect, and work toward meaningful improvements that enhance patient care and workplace experiences. We are dedicated to building a supportive and welcoming environment where everyone has the opportunity to thrive and advance professionally. Explore this opportunity and be part of the next chapter in our history.

About the Mount Sinai Health System:

Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes more than 9,000 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country’s best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 11 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.

Equal Opportunity Employer

The Mount Sinai Health System is an equal opportunity employer, complying with all applicable federal civil rights laws. We do not discriminate, exclude, or treat individuals differently based on race, color, national origin, age, religion, disability, sex, sexual orientation, gender, veteran status, or any other characteristic protected by law. We are deeply committed to fostering an environment where all faculty, staff, students, trainees, patients, visitors, and the communities we serve feel respected and supported. Our goal is to create a healthcare and learning institution that actively works to remove barriers, address challenges, and promote fairness in all aspects of our organization.

Compensation Statement

Mount Sinai Health System (MSHS) provides a salary range to comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $59895 - $83686.38 Annually. Actual salaries depend on a variety of factors, including experience, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.