Prior Authorizations Spec 1 / PAS Fin Clearance Institutes

Position Summary

Under the direction of the Manager, Prior Authorization Services, HHC Cancer Institute, performs all clerical duties required to obtain insurance prior authorizations for chemotherapy and other services in a timely manner. Responsible for maintaining and managing resources, including insurance portal access, and provides consistent documentation in EPIC to support the obtained insurance authorization.

Communicates changes in payer and or federal regulatory guidelines to their manager, pharmacy staff, providers and other clinical departments, as applicable.

Position Responsibilities

• Maintains and reviews the prior authorization work queue daily to verify accuracy of patient’s insurance information and to interpret insurance pre-authorization requirements for scheduled chemotherapy treatments.
• Contacts insurance companies to obtain prior authorization via telephone and/or portals and provides necessary clinical documentation to ensure authorization is obtained prior to the scheduled chemotherapy treatment.
• Documents in EPIC prior authorization information obtained such as number of treatments authorized, length of time treatment is authorized, authorization numbers, and insurance company contact or call reference number.
• Immediately communicates to provider and infusion staff when a chemotherapy drug or plan is denied by the insurance company and communicates insurance company drug preference, if given.
• Collaborates and communicates with pharmacy regarding preferred drugs and biosimilars as required by pharmacy and or insurance company and notifies manager of changes.
• Maintains log of missed prior authorizations and assists manager with monthly audit follow up for denials.
• Collaborates with various hospital departments around billing, information management, policies, procedures and general operations related to prior authorizations.
• Aids in training of new prior authorization staff and other duties as assigned.

Qualifications

• Education: High School Graduate/Diploma
• Experience: Minimum one year experience working with insurances and prior authorizations, preferred
• Knowledge, Skills And Ability Requirements: Experience and knowledge of insurances and prior authorizations; Ability to effectively and professionally communicate with physicians, clinical and administrative staff, managers, patients and insurance companies; Must be self-motivated and have the ability to work independently and within a team; Excellent telephone and customer service skills; Demonstrates excellent computer skills; Must demonstrate strong organizations skills