Dana-Farber Cancer Institute Drug Authorization Specialist in Brookline, Massachusetts
Located in Boston and the surrounding communities, Dana-Farber Cancer Institute brings together world renowned clinicians, innovative researchers and dedicated professionals, allies in the common mission of conquering cancer, HIV/AIDS and related diseases. Combining extremely talented people with the best technologies in a genuinely positive environment, we provide compassionate and comprehensive care to patients of all ages; we conduct research that advances treatment; we educate tomorrow's physician/researchers; we reach out to underserved members of our community; and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.
The Revenue Integrity Specialist reports to the Manager of Prior Authorization and is responsible for working with third-party payors, physicians & other departments within the Revenue Cycle to obtain a prior authorization for services for Dana-Farber patients. Timely follow-up with the payors and performance of administrative tasks related to the Prior Authorization function including spreadsheet and system maintenance. Supports Manager of Prior Authorization.
Review three-times, daily Pre-Cert report to identify drugs for which Prior Authorization is required by the payor
Contact insurance company via phone/fax/email to obtain Prior Authorization for ordered drugs including talking to payor customer service representatives, completing payor forms, gathering any required supporting documentation and sending the information to the payor
Address questions of Prior-Authorization that come to Revenue Integrity directly from departments and as part of off-label process
Track and follow up on all requests for prior authorization and ensure actions taken as part of the Prior Authorization process are documented timely, clearly and accurately into the hospital information systems
Maintain Prior Authorization Tracking Spreadsheet including data entry, reporting and general spreadsheet tasks
Maintain Prior Authorization Payer Rule Spreadsheet including calling providers to understand rules to populate the spreadsheet. Expand the number of payors on the spreadsheet.
Maintain hospital information system Pre-Cert report to add or remove drugs from the report
Follow-up on expiring Prior-Authorization requests and obtain additional authorization if needed
Write an ABN/Waiver document to be signed by patient if prior authorization is not obtained and the physician & patient agree to continue with treatment plan. Collaborate with Access Management to obtain patient signature on document prior to treatment
Resolve authorization denials from Patient Accounting
Meet standards for decision turn around times and communicate with all applicable parties on the outcome of each request
Support Prior Authorization manager
Completes assigned work queues, projects, and other duties as assigned
High School Diploma/GED required
College education preferred
Prior healthcare experience strongly preferred
Knowledge of insurance coverage authorization policies preferred
Knowledge of physician or hospital registration or billing systems preferred; GE Centricity systems experience preferred
Strong understanding of Microsoft Office product suite.
Excellent customer service and communication skills, both written and verbal.
Self starter with strong team player and leadership abilities.
Strong analytical and problem solving skills.
Ability to prioritize and meet pre-determined deadlines.
Must be able to effectively multi-task, and have advanced technical skills, as appropriate.
Dana-Farber Cancer Institute is an equal opportunity employer and affirms the right of every qualified applicant to receive consideration for employment without regard to race, color, religion, sex, gender identity or expression, national origin, sexual orientation, genetic information, disability, age, ancestry, military service, protected veteran status, or other groups as protected by law.
Job ID: 2019-13661
External Company URL: www.dana-farber.org