Prior Authorizations Spec 2 / PAS Fin Clearance Institutes

Hartford HealthCare Corp.•Farmington, CT

About The Position

Under the direction of the Manager, Prior Authorization Services, HHC Cancer Institute, the Prior Authorizations Spec 2 obtains insurance prior authorizations for chemotherapy and other services in a timely manner. The position manages resources such as insurance portal access and documents authorization details in EPIC. It reviews and communicates payer and federal regulatory guideline changes to the manager, pharmacy staff, providers, and other clinical departments as applicable. The specialist trains new and contingent prior authorization staff, enrolls staff and provider information in insurance portals and applicable applications, completes the insurance denial work queue, and prepares reports as requested by the manager. The role monitors prior authorization and denial work queues, verifies insurance information, interprets pre-authorization requirements, contacts insurers to obtain authorizations or resolve denials, and ensures required clinical documentation is provided before scheduled treatments. It communicates denials and payer drug preferences to providers and infusion staff, collaborates with pharmacy and other hospital departments, supports audits and policy development, and provides coverage across locations as needed.

Requirements

High school graduate or diploma.
Minimum 3 years of experience working with insurance, denials and appeals, and prior authorizations (listed as preferred in the posting).
Experience and knowledge of insurance and prior authorizations.
Ability to communicate effectively and professionally with physicians, clinical and administrative staff, managers, patients, and insurance companies.
Ability to work independently and as part of a team; must be self-motivated.
Excellent telephone and customer service skills.
Excellent computer skills.
Strong organizational skills.

Nice To Haves

Associate degree.
Experience working with insurance, denials and appeals, and prior authorizations.

Responsibilities

Monitor denial work queues daily, contact insurance companies to resolve denials and appeals, and report denial trends to the manager.
Review prior authorization work queues daily to verify patient insurance information and interpret pre-authorization requirements for scheduled treatments.
Contact insurance companies by telephone or through portals to obtain prior authorizations and provide necessary clinical documentation before scheduled treatments.
Document authorization details in EPIC, including authorized treatments, authorization duration, authorization numbers, and insurer contacts or reference numbers.
Immediately notify providers and infusion staff when a chemotherapy drug or plan is denied, and communicate any drug preferences provided by the insurer.
Collaborate and communicate with pharmacy regarding preferred drugs and biosimilars, and notify the manager of changes.
Maintain a log of missed prior authorizations and assist the manager with monthly audit follow-up for denials.
Collaborate with hospital departments on billing, information management, policies, procedures, and operations related to prior authorizations.
Train new prior authorization staff and travel to various locations when necessary.
Monitor work queues for all locations and provide assistance as needed.
Enroll new staff and providers in insurance portals.
Serve as a resource to other prior authorization staff.
Review insurance updates and communicate changes related to prior authorizations.
Assist the manager with developing policies and standard work for obtaining prior authorizations.
Complete other duties as assigned.