Authorization Counselor - Manhattan, OB/GYN (IVF)

Authorization Counselor - Manhattan, OB/GYN (IVF)

Administrative/Office Support

New York, NY ID: 1161449_RR00119462 Full-Time/Regular

NYU Grossman School of Medicine is one of the nation's top-ranked medical schools. For 175 years, NYU Grossman School of Medicine has trained thousands of physicians and scientists who have helped to shape the course of medical history and enrich the lives of countless people. An integral part of NYU Langone Health, the Grossman School of Medicine at its core is committed to improving the human condition through medical education, scientific research, and direct patient care. At NYU Langone Health, equity and inclusion are fundamental values. We strive to be a place where our exceptionally talented faculty, staff, and students of all identities can thrive. We embrace inclusion and individual skills, ideas, and knowledge.

Position Summary: We have an exciting opportunity to join our team as a Authorization Counselor - Manhattan, OB/GYN (IVF). In this role, the successful candidate Using demographic, insurance and medical information from Epic and existing EMRs together with existing patient schedules, reviews benefit plans and obtains prior authorization from par and non-par carriers related to fertility treatment and pharmaceutical protocols.

Job Responsibilities:

• Performs other duties as assigned.
• Navigate insurance portals to obtain fertility benefit plans, verification/pre-authorization requirements.
• Utilizes information from systems (EPIC & FERT & eIVF) to obtain anticipated treatment plans (including medication prescriptions) and translate treatment plan into necessary CPT codes in order to obtain authorization from carriers.
• Adheres to schedules for ensuring authorizations are obtained and securely relayed to patients and clinical team members to ensure cycles can proceed without delay.
• Interacts with participating carriers and partner carriers {Progyny, Maven, Stork Club} to provide applicable information via completing forms or on line surveys to obtain authorization information medical history, treatment plan, Rx, etc.
• Recognizes non-conforming authorization decisions and brings to the attention of the authorization team lead and payor.
• Documents updates related to authorization requirements by payer/employer group as requested- treatment requirements /pharma requirements.
• Communicates to patients by telephone or email, decisions of the payor regarding authorization of treatment and pharma, including denials and pends. Documents all information in medical record and Epic.
• Responds to patient inquiries, issues, and requests via email and telephone and on site in a timely and professional manner. Must be adept at relaying unexpected information to patients regarding fees and costs.
• Acts as a team resource regarding need for and process for authorization.
• Communicates those authorization cases denied for medical necessity or requiring peer-to-peer review to the referring physician/admin staff for clarification/ information/direction.
• Sends timely requests to referring physicians for information/clarification of plan
• Maintains cooperative and professional relationships with physicians, nurses, lab, office and billing staff. Cooperates with supervisor and all members of the team.

Minimum Qualifications: To qualify you must have a High School Diploma 2 years relevant experience or the equivalent combination of education and experience. Knowledge of insurance carriers procedures and policies, CPT codes and ICD10 codes

Preferred Qualifications: Experience with insurance verifications or authorizations in a fertility practice Knowledge of pharmaceutical and medical services available to fertility patients

Qualified candidates must be able to effectively communicate with all levels of the organization. NYU Grossman School of Medicine provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents. At NYU Langone Health, we are committed to supporting our workforce and their loved ones with a comprehensive benefits and wellness package. Our offerings provide a robust support system for any stage of life, whether it's developing your career, starting a family, or saving for retirement. The support employees receive goes beyond a standard benefit offering, where employees have access to financial security benefits, a generous time-off program and employee resources groups for peer support. Additionally, all employees have access to our holistic employee wellness program, which focuses on seven key areas of well-being: physical, mental, nutritional, sleep, social, financial, and preventive care. The benefits and wellness package is designed to allow you to focus on what truly matters. Join us and experience the extensive resources and services designed to enhance your overall quality of life for you and your family. NYU Grossman School of Medicine is an equal opportunity employer and committed to inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration.

NYU Langone Health provides a salary range to comply with the New York state Law on Salary Transparency in Job Advertisements. The salary range for the role is $43,656.26 - $63,189.02 Annually. Actual salaries depend on a variety of factors, including experience, specialty, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.