City
 
Date Posted
10 / 15 / 2020
Grade
16
Hours Required
40 Hours
Department
Preadmission Review
Schedule
Full-Time
Education
Associates Degree Required
Location
Mount Auburn Hospital - Cambridge, MA

Authorization Specialist

Mount Auburn Hospital - Cambridge, MA

Description:

Principal Duties and Responsibilities

1. Responsible for researching and pre authorizing cancer services before they are provided working with various parties such as insurers, pharmaceutical companies and the MAH Radiology, Lab, Pharmacy and Finance Departments.  

2. Conducts prior authorization for all pre medications, primary chemotherapy drugs and supportive drugs. This involves research into the Medicare system, utilizing off label drug compendiums and direct authorization work with patient primary and secondary insurers. Will require close interaction with Department physicians, mid level practitioners, nurses and medical secretaries.  

3. Receives written prescriptions or requests for prescription refills from patients and verifies that the information on the prescription is complete and accurate.  

4. Develops and maintains effective relations with physician office staff.  

5. Perform routine communication as needed to adequately assure results are reported accurately and timely.  

6. Responsible for answering phones, insurance verification and eligibility, pre-certification and securing authorization for inpatient and outpatient services, self pay, commercial, and Medicare or third party reservations.    

7. Process all required paperwork according to established procedures.

Requirements:

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED

1. High School graduate, Associates Degree preferred. Related Medical/Technical degree desirable.

2. Minimum of three years experience in a Hematology Oncology environment with exposure to the patient population and the types of services patients receive. Coding and prior authorization experience involving oncology drugs and ancillary testing desirable.  

3. Medical coding desirable

4.  Strong communication skills required

5. Knowledge of medical terminology, medical insurance, covered services and those that require prior authorization.  Knowledge of oncology services, drug regimens and associated regulations.