Complex Authorization Coordinator - Cancer Center * Days - 40hrs/wk.

Shift: Days | Full-time (1.0 FTE) | No on-call or weekend requirements

About the Role

The Complex Authorization Coordinator consults with patients to obtain insurance verification, authorization, and financial clearance for pediatric and adult cancer and non-cancer infusions. Responsibilities include benefit investigation, reviewing patient out-of-pocket costs and deductibles, managing step therapy requirements, reviewing FDA, NCCN, and/or LCD guidelines for diagnosis and dosing, assessing site-of-care insurance mandates, evaluating biosimilar options, facilitating outmigration to home care, handling white-bagging requirements, coordinating patient assistance programs, and managing off-label drug request appeals and denials.

Responsibilities

• Obtain insurance approvals for adult and pediatric cancer and non-cancer infusion services.
• Review patient benefit levels to determine cost-share out-of-pocket expenses for upcoming procedures and infusion services.
• Communicate cost-share expectations to patients and collect pre-payments for services.
• Verify and update patient demographic and insurance information as needed.
• Provide insurance verification for coverage changes.
• Manage daily work queues and incorporate Lean principles into daily workflows.
• Function as a collaborative and contributing team member with outstanding customer service skills.
• Schedule new and return complex, adult non-cancer infusion appointments, determining appropriate clinic and utilizing scheduling guidelines.
• Participate on committees, task forces, and workgroups aimed at improving referral operations and patient care.
• Maintain a current knowledge base of department processes, protocols, and procedures.
• Pursue self-directed learning and continuing education opportunities.
• Perform other duties as assigned, including participation in committees or workgroups as determined by management.

Requirements

• High school diploma or GED.
• Minimum of 3-4 years of related experience.
• Excellent time management skills and ability to prioritize tasks.
• Flexibility to work independently and handle multiple tasks.
• Ability to provide support, direction, and development of staff.
• Skill in handling sensitive issues with confidentiality and organizational guidelines.
• Excellent interpersonal and communication skills (verbal and written).
• Strong computer skills.
• Training or experience in managed care insurance plans.
• Knowledge of appointment scheduling processes.
• Ability to prioritize, maintain accurate records, and work under deadlines.
• Excellent customer service skills.