Prior Authorization Specialist – Infusion Care

UMass Memorial Health; Worcester (MA); On-site; USD 29,000 - 40,000; Full time

Job summary

UMass Memorial Health in Worcester, MA is seeking a dedicated Prior Authorization Specialist to support general and oncology infusion clinics. You will review medical necessity, coordinate with insurers, and ensure timely authorizations to maintain uninterrupted patient care.

Working Monday–Friday, 8:00 AM–4:30 PM, you will collaborate with Insurance Verification, Central Billing, and other departments, maintain records, and contribute to our commitment to quality and patient service.

Qualifications

• 2-3 years of medical secretarial/administrative support experience.
• Proficiency with Microsoft Office and internet research.
• Strong customer service and teamwork skills.

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

Teamwork

Education

High School diploma

Tools

All Scripts

IDX

Job description

UMass Memorial Health in Worcester, MA is seeking a dedicated Prior Authorization Specialist to support general and oncology infusion clinics. You will review medical necessity, coordinate with insurers, and ensure timely authorizations to maintain uninterrupted patient care.

Working Monday–Friday, 8:00 AM–4:30 PM, you will collaborate with Insurance Verification, Central Billing, and other departments, maintain records, and contribute to our commitment to quality and patient service.