Prior Authorization Specialist – Infusion Care

C100 UMass Memorial Medical Center, Inc.; United States; On-site; USD 29,000 - 40,000; Full time

Benefits offered by this job

Signing bonus

Job summary

UMass Memorial Health seeks a detail-oriented healthcare administrative professional to join our Pharmacy Business Office. You will complete prior authorization reviews for general and oncology infusions, researching medical necessity and coordinating with insurers to prevent coverage lapses.

Qualifications include a high school diploma and 2–3 years in medical secretarial/administrative support, with proficiency in Microsoft Office.

Qualifications

• High School diploma required.
• 2-3 years of medical secretarial/administrative support experience required.
• Microsoft Office and internet skills required.
• Good customer service skills.
• Ability to work in a team environment.
• Preferred: 6-12 months of prior authorization experience in an infusion setting.
• Preferred: Prior experience using All Scripts, IDX.

Responsibilities

• Completes prior authorization review for all general and oncology infusions.
• Researching medical necessity in reference to patient diagnosis and treatment plan utilizing appropriate compendiums and insurer policies.
• Works with multiple insurance carriers/vendors and keeps current with any and all changes as they relate to prior authorization.
• Communicates / interacts with specific divisions regarding approved or denied prior authorizations.
• Communicates with Insurance Verification, the Central Billing Office and other Departments in order to resolve prior authorization issues.
• Manages the “Incoming Patient Report” ensuring appropriate Prior Authorizations are in place.
• Utilizing appropriate databases, tracking mechanisms, and tools, manages all prior authorization renewals to assure no lapse in medication treatment coverage.
• Coordinates process for authorization using defined best practices.
• Participates in the management of a shared database which holds all prior authorization numbers and makes edits as needed.
• Assists in the maintenance of the Prior Authorization Best Practices manual which includes prior authorization requirement changes made by the insurance carriers and makes recommendations for changes.
• Performs weekly prior authorization audit to ensure accurate billing and resolves issues that arise.
• Produces correspondence, reports, memos, etc. as required.
• Sets up and maintains confidential, sensitive files and records for multiple functions, academic materials, medical records, etc. ensuring efficient retrieval of information.
• Coordinates retrieval of medical records.
• Ensures adequate inventory of office supplies and basic maintenance of office equipment.
• Participates in performance improvement initiatives and demonstrates the use of quality improvement in daily operations.
• Ensures compliance with health and safety requirements and with regulatory agencies such as DPH, etc.

Skills

Microsoft Office

Customer service

Team environment

Education

High School diploma

Tools

All Scripts

IDX

Job description

UMass Memorial Health seeks a detail-oriented healthcare administrative professional to join our Pharmacy Business Office. You will complete prior authorization reviews for general and oncology infusions, researching medical necessity and coordinating with insurers to prevent coverage lapses.

Qualifications include a high school diploma and 2–3 years in medical secretarial/administrative support, with proficiency in Microsoft Office.