Drug Authorization Specialist

Responsibilities:

• Obtains pre-authorizations for Physician Orders as required by the patient’s insurance carrier.
• 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 as assigned to help drive our mission of improving the lives of everyone living with cancer.
• Required or Preferred Qualifications:
• High School diploma or equivalent required.
• Medical insurance background.
• Must be willing and able to lift up to 25 pounds.
• Must be willing and able to travel to satellite clinics when necessary.
• 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 operate various types of office equipment.
• #LI-REMOTE