Drug Authorization Specialist

About the role

This role functions as a liaison between clinical staff, physicians, and patient accounting, ensuring that patient’s insurance requirements for reimbursement are met before treatment occurs while maintaining knowledge on drugs used to treat patients. Communicate as needed with patients on coverage that may affect their financial liability.

Responsibilities

• Obtains pre-authorizations for Physician Orders as required by the patient’s insurance carrier.
• Communicates with physician/clinical staff on reimbursement issues and/or pre-certification requirements by the patient’s insurance carriers.
• Communicates with physician/clinical staff concerning off-label drug use.
• Coordinates and communicates information required or requested by Patient Accounting within the mandated timeframe.
• Ensures up-to-date documentation on patient’s accounts in Electronic Medical Record and Patient Management on follow-up or ongoing drug authorizations.
• Keeps current on drug and insurance carrier requirements. Utilizes all available sources to stay abreast of drug information (indications, Pharma programs, pre-certification requirements, etc.).
• Follows policy and procedures outlined by management to ensure standardization of processes across the clinics.
• Responsible for patient assistance coordination with the Patient Advocate and communicates with clinical staff to coordinate treatment plan requirements for indigent drug.
• Educates patients about their insurance coverage and benefits, including deductible, copay, coinsurance, and estimated out-of-pocket costs as needed.
• Determines patient financial ability to pay and provides financial counseling services regarding payment arrangements and financial assistance for uninsured and underinsured patients by phone or in person as needed.
• Maintains continued authorizations of drugs ensuring that all treatment dates are covered for reimbursement.
• Resolves items in task management related to drug authorization issues.
• Additional responsibilities as assigned to help drive our mission of improving the lives of everyone living with cancer.

Requirements

• High School diploma or equivalent required.
• Medical insurance background.
• Must be willing and able to lift up to 25 pounds.
• Must be willing and able to travel to satellite clinics when necessary.

Skills

• Attendance is an essential job function.
• Excellent written and verbal communication skills with the ability to effectively communicate and establish collaborative relationships with physicians, patients, clinical and administrative staff, and the public.
• Excellent customer service skills.
• Knowledge of clinic office procedures, medical practice, and medical terminology.
• Ability to recognize, evaluate, and solve problems.
• Strong organizational skills and attention to detail.
• Proficient in the use of end-user computer applications regarding productivity (MS Word, Excel, Outlook), database, and patient scheduling and other medical information systems.
• Ability to operate various types of office equipment.