Specialist, Authorization

Summit Health•Wethersfield, CT

3d•$16 - $23•Onsite

About The Position

This role is responsible for verifying insurance/managed care plans for eligibility for all listed insurance plans in the patient account and documenting this information. The Specialist will use Athena to confirm eligibility or contact the payer directly, documenting the outcome. A key responsibility is to obtain prior authorizations for infusion plans in a timely manner to avoid delaying patient treatment. The Specialist will also pre-certify patient infusions and injections by confirming eligibility and determining if prior authorization is necessary. Additionally, they will advise staff on insurance plan updates and authorize specialty pharmacy drugs, maintaining an accounting through the PBM log system.

Requirements

High School graduate or equivalent
Prior medical office experience required
Knowledge of insurance company/managed care organization constraints related to the retinal practice’s office procedures, visits, testing and drug therapy.
Must have a high level of customer service, interpersonal and organizational skills
Must be able to multi-task and handle a fast-paced busy environment
Strong working knowledge of basic computer programs, and good typing skills
Ability to plan, prioritize, and complete delegated tasks in a reasonable span of time
Ability to work independently and as a member of a team
This position may require cross-coverage of other positions, as needed, and therefore a measure of flexibility to respond adequately to changing demands is required

Nice To Haves

Prior Authorization Certified Specialist (PACS) preferred
prior authorization experience of one year strongly preferred

Responsibilities

Verifies insurance/managed care plans for eligibility for all of the insurance plans listed in the patient account and documents information in TxM and Athena.
Uses Athena to confirm eligibility and/or contacts the payer directly and documents the outcome in the patient account.
Obtain prior authorizations for each infusion plan listed on each day in a timely manner to as not to delay treatment for patients.
Pre-certify all patient infusions and injections by confirming their insurance/managed care plan eligibility in addition to confirming whether prior authorization for visits and treatments are necessary.
Advises staff of any insurance plan updates.
Authorize specialty pharmacy drugs for patients and maintains an accounting through the PBM log system.