Prior Authorization Coordinator, Pharmacy Business office, Per Diem

UMass Memorial Health•Worcester, MA

1d•$17 - $31

About The Position

Everyone Is a Caregiver At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day. Obtains authorization numbers from insurance companies, reviews all prior authorization requests for medical necessity, and determines appropriate benefit coverage for all general and oncology infusion clinics supported by the Pharmacy Business office.

Requirements

High School diploma
2-3 years of medical secretarial/administrative support experience.
Microsoft Office and internet skills required.
Good customer service skills.
Ability to work in a team environment.

Nice To Haves

6 -12 months of prior authorization experience in an infusion setting preferred.
Prior experience using All Scripts, IDX, preferred.

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.