Complex Authorization Coordinator - Gastroenterology Days - 40hrs/wk.

umhealthwest•Wyoming, MI

About The Position

Under the limited direction, the Complex Authorization Coordinator consults with patients to obtain insurance verification and/or authorization and financial clearance for peds and adult cancer and non-cancer infusions. Benefit investigation, review patient out of pocket/deductible, step therapy trial and fail, review FDA, NCCN and/or LCD for diagnosis and dosing, site of care insurance mandate, review for biosimilar, review for outmigration to home obtain authorization, review white bagging requirements, patient assistance, patient financial counselor assistance, off label drug request appeals and denials.

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 manage 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 in order to determine cost share out of pocket expense for upcoming procedure and infusion services.
Communicate with patients their cost share expectations 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.
Participates on committees, tasks forces, and workgroups charged with improving referral operations and patient care.
Performs other duties as assigned. These may include but are not limited to: Maintaining a current knowledge base 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.