Complex Authorization Coordinator

Complex Authorization Coordinator - Professional Medical Oncology * Days - 40hrs/wk.

Shift: Days

General Summary:

Under the limited direction, the Complex Authorization Coordinator consults with patients to obtain insurance verification and/or authorization and financial clearance for peds and adult cancer and non-cancer infusions. Benefit investigation, review patient out of pocket/deductible, step therapy trial and fail, review FDA, NCCN and/or LCD for diagnosis and dosing, site of care insurance mandate, review for biosimilar, review for outmigration to home obtain authorization, review white bagging requirements, patient assistance, patient financial counselor assistance, off label drug request appeals and denials.

Requirements:

• High school diploma or GED
• Minimum of 3-4 years of related experience
• Excellent time management skills and ability to prioritize tasks
• Flexibility to work independently and handle multiple tasks
• Ability to provide support, direction and development of staff
• Ability to skillfully handle issues of a sensitive nature with respect to confidentiality and organizational guidelines
• Excellent interpersonal skills and communication skills
• Excellent computer skills
• Training or experience in manage care insurance plans
• Knowledge of appointment scheduling process
• Communicate effectively, both verbal and written
• Able to prioritize, maintain accurate records, and work under deadline
• Excellent customer service skills

Essential Functions & Responsibilities:

1. Obtain insurance approvals for Adult and Pediatric Cancer and Non-Cancer Infusion Services.
2. Review patient benefit level in order to determine cost share out of pocket expense for upcoming procedure and infusion services.
3. Communicate with patients their cost share expectations and collect pre-payment for services.
4. Verify and update patient demographic and insurance information as needed,
5. Provide insurance verification for coverage changes.
6. Manage daily work queues.
7. Incorporate and practice Lean principles into daily work.
8. Function as a collaborative and contributing team member.
9. Demonstrate outstanding customer service skills.
10. Schedule new and return complex, adult non-cancer infusion appointments, determining appropriate clinic and utilizing scheduling guidelines and informational tools.
11. Participates on committees, tasks forces, and workgroups charged with improving referral operations and patient care.
12. Performs other duties as assigned. These may include but are not limited to: Maintaining a current knowledge base of department processes, protocols and procedures, pursuing self-directed learning and continuing education opportunities, and participating on committees, task forces, and work groups as determined by management.

Requisition #: req8481