Job Description:
Do you have experience in health care prior-authorizations of
drugs and medications? Are you looking to work from home with
company-provided equipment and an internet stipend? Do you want a
good work-life balance with paid time off up to 3.5 weeks in your
first year plus 10 paid company holidays? Do you take pride in
knowing that you are making a difference every day in the lives of
people with cancer and blood disorders? If you are then look no
further than New England Cancer Specialists (NECS), a proud Dana
Farber affiliate.
NECS is currently seeking a full-time, Monday-Friday
remote Drug-Prior Authorization Specialist. Our Prior
Authorization Specialists are responsible for acquiring insurance
prior authorizations for all NECS patients, as directed through
dedicated physician teams. This position makes substantial outbound
calls to insurance companies and utilizes multiple insurance online
payer portals to complete prior authorizations primarily for
oncology and hematology treatments. The ideal candidate will be
comfortable answering multi-line phone systems, triaging calls,
resolving issues, and answering questions from patients and
insurance companies. They will be able to take detailed messages and
redirect / forward calls as necessary. Our Prior Authorization
Specialists maintain confidentiality, meet deadlines to advance
patient care promptly, demonstrate superior customer service skills
and the ability to be effective team players as well as function at
high levels independently.
This position is primarily remote, with training and coverage as
needed on-site in Scarborough ME.
NECS is a private medical practice composed of 13 oncologists
and hematologists serving the region from 5 different locations in
Maine and New Hampshire. Our mission is to make life better for
people with cancer and blood disorders. Kindness, compassion, and
respect are part of everything that we do - from our phone operators
to our physicians, every person on our team is important, and
everyone makes a difference. We are proud to be the first Dana
Farber Affiliate practice in the country, striving to provide the
highest quality care and unmatched, holistic support for every
patient, every day.
Job Duties:
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Complete prior authorizations for all tasked orders.
Communicate clearly with physicians and physician-lead teams any
issues or delays in the completion of tasks/authorizations.
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Documents clearly and accurately within the Electronic Medical Record
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Collect and submit all pertinent clinical information to
insurance companies to ensure accurate authorization requests
ultimately resulting in approvals.
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Check to ensure diagnosis supports treatment ordered and is
covered per FDA and NCCN guidelines utilizing tools provided.
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Familiarize oneself and have a strong working knowledge of
various insurance company’s medical policies regarding specific medications.
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Work alongside the pharmacy department when new drugs are
requested and or changed based on new criteria and or updated
pricing strategies.
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Utilize various online portals/platforms to request and obtain
accurate authorizations.
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Assist the billing office in the claim’s appeals process when necessary.
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Communicates consistently and frequently with provider teams
and Financial Advocates all changes to and or those issues which
may affect a patient’s overall care planning to ensure best
possible outcomes for every patient.
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Returns all phone calls by the end of the same business day.
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Scans medical records according to NECS guidelines.
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Sorts and routes incoming mail and faxes for prior
authorization department.
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Communicates clearly and professionally to patients and staff.
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Successfully maintain a pleasant, professional demeanor under
stressful conditions.
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Other duties as assigned Financial Advocate Manager.
Travel: Occasional to Scarborough, ME Clinic is required.
