Prior Authorizations Spec 1 / PAS Fin Clearance Institutes

Prior Authorization Specialist

Work where every moment matters. Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network.

The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization. With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.

Position Summary:

Under the direction of the Manager, Prior Authorization Services, HHC Cancer Institute, performs all clerical duties required to obtain insurance prior authorizations for chemotherapy and other services in a timely manner. Responsible for maintaining and managing resources, including insurance portal access, and provides consistent documentation in EPIC to support the obtained insurance authorization. Communicates changes in payer and or federal regulatory guidelines to their manager, pharmacy staff, providers and other clinical departments, as applicable.

Position Responsibilities:

Key Areas of Responsibility:

• Monitors and reviews the prior authorization work queue daily to verify accuracy of patient's insurance information and to interpret insurance pre-authorization requirements for scheduled chemotherapy treatments.
• Contacts insurance companies to obtain prior authorization via telephone and/or portals and provides necessary clinical documentation to ensure authorization is obtained prior to the scheduled chemotherapy treatment.
• Documents in EPIC prior authorization information obtained such as number of treatments authorized, length of time treatment is authorized, authorization numbers, and insurance company contact or call reference number.
• Immediately communicates to provider and infusion staff when a chemotherapy drug or plan is denied by the insurance company and communicates insurance company drug preference, if given.
• Collaborates and communicates with pharmacy regarding preferred drugs and biosimilars as required by pharmacy and or insurance company and notifies manager of changes.
• Maintains log of missed prior authorizations and assists manager with monthly audit follow up for denials.
• Collaborates with various hospital departments around billing, information management, policies, procedures and general operations related to prior authorizations.
• Assists with training of new prior authorization staff and other duties as assigned.

Working Relationships:

This Job Reports To: Manager, Prior Authorization Services, HHC Cancer Institute

Qualifications

Requirements and Specifications:

• Education: High School Graduate/Diploma
• Experience: Minimum one year experience working with insurances and prior authorizations, preferred
• Knowledge, Skills and Ability Requirements:
• Experience and knowledge of insurances and prior authorizations
• Ability to effectively and professionally communicate with physicians, clinical and administrative staff, managers, patients and insurance companies
• Must be self-motivated and have the ability to work independently and within a team
• Excellent telephone and customer service skills
• Demonstrates excellent computer skills
• Must demonstrate strong organizational skills

We take great care of careers. With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.