State Operations Coverage Specialist

Position Summary The State Operations Coverage Specialist handles day-to-day operational work in support of PFA's Pennsylvania team. The role confirms that the services, providers, and medications families need are in network, and solves coordination of benefits issues so families can get the care and medications they need. Success in this role takes strong problem-solving, close attention to detail, and a willingness to build deep knowledge of Pennsylvania Medicaid and the PA HIPP program. Key Responsibilities Network & Coverage Verification (45%) Confirm that all services, providers, and medications are in network with both Employer-Sponsored Insurance (ESI) and Fee-for-Service (FFS) Medicaid. Coordination of Benefits & Problem-Solving (45%) Resolve coordination of benefits issues. Help families obtain prior authorizations as needed. Resolve pharmacy issues and help families obtain medications as needed. Team Support & Other Duties (10%) Participate in team meetings and complete follow-ups. Perform other duties as needed. Required Qualifications Education High school diploma or GED, and completion of formal training or coursework in healthcare administration, patient services, or a similar field. Minimum Experience At least 2 years of experience in insurance verification, prior authorization, Medicaid or managed care, pharmacy benefits, or revenue cycle. Preferred Qualifications Bachelor's degree in healthcare administration, patient services, or a related field