Coordinator I - Research Infusion Authorization

30 Shea Medical Center; United States; Hybrid; USD 55,000 - 70,000; Full time

Job summary

HonorHealth Research Institute in Arizona seeks a Research Infusion Authorization Coordinator I to initiate and obtain prior authorizations for clinical trials, infusion/chemotherapy, and related medications. You will work with clinical and administrative teams to prevent denials by confirming medical necessity and ensuring timely approvals.

You will verify insurance eligibility, document EMR notes, coordinate with physicians, pharmacy staff, and billing, and assist patients with financial

Qualifications

• High school diploma or GED required.
• Technical training diploma/degree preferred.
• 1 year prior authorization experience required.

Responsibilities

• Initiates and obtains prior authorizations for clinical trials and infusion/chemotherapy and supportive drugs, prescription drugs, DME, and radiology.
• Verifies insurance eligibility and benefits, documents the EMR in detail, and adheres to payer requirements.
• Communicates with patients, physicians, infusion staff and other personnel within the organization.
• Coordinates with billing to maintain accurate account notes and ensure correct billing.

Education

High School Diploma or GED

Technical Training Diploma/Degree

Job description

Primary City/State: Research Institute - 10510 N 92nd St Scottsdale, AZ 85258

Category: Laboratory Services

Shift: Day

Department: HRI-Front Office and PFCs Hybrid, must reside in Arizona

Great care starts with great people. (Like you.) At HonorHealth, you’ll find something special. From humble beginnings in 1927 to one of Arizona’s largest nonprofit healthcare systems, our culture is built on warmth and neighborly kindness. Behind every smile is a highly skilled professional with deep expertise and an unwavering dedication to what matters most — caring for the health and well-being of people and communities across the greater Phoenix area.

Responsibilities

The Research Infusion Authorization Coordinator I position within the HonorHealth Research Institute initiates and obtains prior authorizations for clinical trials and continuing care infusion/chemotherapy and supportive drugs, prescription drugs, DME, and radiology. Working closely with clinical and administrative teams to prevent denials by ensuring medical necessity and obtaining prior authorizations promptly. Coordinating the approval process for white bag, manufacturer assistance and compassionate use medication. Optimizing processes to protect the organization's financial goals and patient liability, which involves organizing workflow, tracking critical information, and contacting physicians and pharmacy staff for required documentation. Verifying insurance eligibility and benefits, documenting the EMR in detail, and adhering to all third-party payer requirements. Consults with patients regarding clinical trial financial paperwork. Provides and assists with information concerning basic financial assistance through the HonorHealth Network.

• Preforms tasks related to the management of prior authorization for patients served by HonorHealth Research Institute.
• Reviews medical records for submission to insurances, abstracting information from the patient medical records pertaining to patient treatments, procedures and guidelines as required.
• Review’s patient treatment plan including frequency and dosage prior to treatment and reviews the applicable payer reimbursement criteria to ensure that the specific payer’s medical necessity criteria is met.
• Obtains approval, authorization and or predetermination for all chemotherapy and non-chemotherapy infusion drugs, pharmacy, DME and radiology prior to treatment.
• Communicates clearly, effectively, and respectfully with patients, physicians, infusion staff and other personnel within the organization.
• Provide results of the authorizations and or predeterminations.
• Communicates payer criteria to providers and or patients as requested.
• Initiates appeals and schedules peer to peer consultations as needed for denials.
• Provides formulary assistance for clinic through evaluating payer requirements.
• Assists in the maintenance and communication of changing payer and pharmaceutical information specific to coordination of patient needs, benefits, and medical necessity.
• Enters complete and accurate notes regarding benefits, authorization, and predeterminations.
• Responsible for coordination of outpatient infusion site replacement /free medication applications for those patients needing financial assistance, as well as ordering medication and refills including setting up delivery to pharmacy site and tracking shipments.
• Must work closely with pharmacy personnel to confirm delivery and account for packing slips.
• Works to screen and track applications to pharmaceutical manufacturers for medication replacement for off label drug use.
• Must communicate with patients and providers on status of applications.
• Must also be in communication with medical staff to verify if treatment plan is still accurate prior to ordering medications.
• Must coordinate the ordering of additional doses with pharmacy personnel.
• Must also work closely with billing department to maintain accurate account notes to ensure correct billing.
• Verifies patients’ insurance eligibility and coverage, confirms authorization status to avoid non-compliance and penalties to the patient, health system and physician.
• Collaborates with staff members to ensure patient status is correct and documentation is provided to insurances as needed.
• Ability to discuss self-pay policies for non-covered services.
• Conducts financial consult with patients enrolled in a clinical trial, reviewing sponsor payments, travel reimbursement, and collection of all required documentation.
• Reconciles reimbursement forms and receipts, inputs data into specific platforms and reimbursement portals.
• Collaborates with accounting department to confirm accuracy and distribution of reimbursement.
• Review the Phil’s Fund Charity program to qualified patients while guiding them through the enrollment process and entering data into the funding portal.
• Conducts outbound and inbound communications with patients, responding to questions and concerns, and facilitate problem-solving.
• Perform data entry of actions and responses and enter notes into EMR system regarding prior authorizations and benefits.
• Verify patients’ insurance eligibility and coverage, ensuring correct patient status and documentation.
• Discuss and assist with basic financial assistance and self-pay policies for non-covered services.
• Other duties as assigned.

Education

High School Diploma or GED Required

Technical Training Diploma/Degree Vocational/Technical training 2 years of college or technical school Preferred

Experience

1 year, Prior authorization experience Required

2 years, of medical experience in a registration related area or scheduling of employees, or coding; including but not mandatory – medical terminology Preferred

2 years, Medical/Dental/Insurance office experience Preferred

About HonorHealth

We're all in for your career. Expert care from experts who care.

Our culture is built on warmth and neighborly kindness, but behind every smile is a highly skilled professional with deep expertise and unwavering dedication. We’re delivering a healthcare experience that simply feels better through:

• Nine acute-care hospitals
• Over 200 primary, specialty and urgent care centers
• More than 17,000 team members and 4,000 medical staff

Since 1927, we’ve been focused on doing what matters most — caring for people and communities across the greater Phoenix area. From humble beginnings to one of Arizona’s largest nonprofit healthcare systems, we’re just as driven as we were a century ago. Come join us and go all in for your career.

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