Drug Authorization Specialist

Responsibilities:

• Communicates with physician/clinical staff on reimbursement issues and/or pre-certification requirements by the patient’s insurance carriers. 

• Communicates with physician/clinical staff concerning off label drug use.

• Coordinates and communicates information required or requested by Patient Accounting within the mandated timeframe. 

• Ensures up-to-date documentation on patient’s accounts in Electronic Medical Record and Patient Management on follow up or ongoing drug authorizations.  

• Keeps current on drug and insurance carrier requirements. Utilizing all sources available to stay abreast of drug information (indications, Pharma programs, pre-certification requirements etc.)

• Follows policy and procedures outlined by management to ensure standardization of processes across the clinics.

• Responsible for patient assistance coordination with the Patient Advocate and communicates with clinical staff to coordinate treatment plan requirements for indigent drug.

• Educate patients about their insurance coverage and benefits, including deductible, copay, coinsurance and estimated out of pocket costs as needed.

• Determine patient financial ability to pay and provide financial counseling services regarding payment arrangements and financial assistance for uninsured and underinsured patients by phone or in person as needed.

• Maintains continued authorizations of drugs ensuring that all treatment dates are covered for reimbursement.

• Resolve items in task management related to drug authorization issues.

• Additional responsibilities may be assigned to help drive our mission of improving the lives of everyone living with cancer.

Required Qualifications:

• High School diploma or equivalent required.

• Medical insurance background

Essential Competencies:

•  Attendance is an essential job function.

• Excellent written and verbal communication skills with the ability to effectively communicate and establish collaborative relationships with physicians, patients, clinical and administrative staff, and the public.

• Excellent customer service skills.

• Knowledge of clinic office procedures, medical practice and medical terminology.

• Ability to recognize, evaluate and solve problems.

• Strong organizational skills and attention to detail.

• Proficient in the use of end-user computer applications regarding productivity (MS Word, Excel, Outlook), database and patient scheduling and other medical information systems.

• Ability to operatevarious types of office equipment.