Prior Authorizations Spec 2 / PAS Fin Clearance Institutes

Hartford Healthcare•Farmington, CT

12h

About The Position

Under the direction of the Manager, Prior Authorization Services, HHC Cancer Institute, the Prior Authorizations Specialist performs the duties necessary to obtain insurance prior authorizations for chemotherapy and other services in a timely manner. The role maintains resources such as insurance portal access and documents authorization information 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 providers in insurance portals and applicable applications, completes the insurance denial work queue, and provides reports as requested by the manager. The role also supports authorization work across locations and contributes to policies and standard work for obtaining prior authorizations.

Requirements

High school diploma or equivalent.
At least 3 years of experience working with insurance, denials and appeals, and prior authorizations; the posting labels this experience as preferred.
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.
Excellent telephone and customer service skills.
Excellent computer skills.
Strong organizational skills.

Nice To Haves

Associate degree.
Three years of 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 phone or portal to obtain prior authorizations and submit necessary clinical documentation before scheduled treatment.
Document authorization details in EPIC, including authorized treatments, authorization duration and numbers, and insurance company contact or call reference numbers.
Immediately notify providers and infusion staff when chemotherapy drugs or treatment plans are denied, including communicating any insurance-preferred drug.
Collaborate 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 general 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 in developing policies and standard work for obtaining prior authorizations.
Complete other duties as assigned.