Complex Authorization Coordinator - Cancer Center Days - 40hrs/wk.

umhealthwest•Wyoming, MI

5d•Onsite

About The Position

Under limited direction, the Complex Authorization Coordinator consults with patients to obtain insurance verification and/or authorization and financial clearance for pediatric and adult cancer and non-cancer infusions. This role involves benefit investigation, reviewing patient out-of-pocket expenses and deductibles, understanding step therapy trial and fail requirements, reviewing FDA, NCCN, and/or LCD for diagnosis and dosing, understanding site of care insurance mandates, reviewing for biosimil usage, obtaining authorization for outmigration to home, reviewing white bagging requirements, assisting with patient assistance programs, collaborating with patient financial counselors, and handling appeals and denials for off-label drug requests.

Requirements

High school diploma or GED
Minimum of 3-4 years of related experience
Excellent time management skills and ability to prioritize tasks
Flexibility to work independently and handle multiple tasks
Ability to provide support, direction and development of staff
Ability to skillfully handle issues of a sensitive nature with respect to confidentiality and organizational guidelines
Excellent interpersonal skills and communication skills
Excellent computer skills
Training or experience in managed care insurance plans
Knowledge of appointment scheduling process
Communicate effectively, both verbal and written
Able to prioritize, maintain accurate records, and work under deadline
Excellent customer service skills

Responsibilities

Obtain insurance approvals for Adult and Pediatric Cancer and Non-Cancer Infusion Services.
Review patient benefit level to determine cost share and out-of-pocket expense for upcoming procedures and infusion services.
Communicate cost share expectations to patients and collect pre-payment for services.
Verify and update patient demographic and insurance information as needed.
Provide insurance verification for coverage changes.
Manage daily work queues.
Incorporate and practice Lean principles into daily work.
Function as a collaborative and contributing team member.
Demonstrate outstanding customer service skills.
Schedule new and return complex, adult non-cancer infusion appointments, determining appropriate clinic and utilizing scheduling guidelines and informational tools.
Participate on committees, task forces, and workgroups charged with improving referral operations and patient care.
Perform other duties as assigned, including maintaining current knowledge of department processes, protocols, and procedures, pursuing self-directed learning and continuing education opportunities, and participating on committees, task forces, and work groups as determined by management.