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The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.
With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.
Position Summary:
Under the direction of the Manager, Prior Authorization Services, HHC Cancer Institute, performs all clerical duties required to obtain insurance prior authorizations for chemotherapy and other services in a timely manner. Responsible for maintaining and managing resources, including insurance portal access, and provides consistent documentation in EPIC to support the obtained insurance authorization. Communicates changes in payer and or federal regulatory guidelines to their manager, pharmacy staff, providers and other clinical departments, as applicable.
Position Responsibilities:
Key Areas of Responsibility
Monitors and reviews the prior authorization work queue daily to verify accuracy of patient’s insurance information and to interpret insurance pre-authorization requirements for scheduled chemotherapy treatments.
Contacts insurance companies to obtain prior authorization via telephone and/or portals and provides necessary clinical documentation to ensure authorization is obtained prior to the scheduled chemotherapy treatment.
Documents in EPIC prior authorization information obtained such as number of treatments authorized, length of time treatment is authorized, authorization numbers, and insurance company contact or call reference number.
Immediately communicates to provider and infusion staff when a chemotherapy drug or plan is denied by the insurance company and communicates insurance company drug preference, if given
Collaborates and communicates with pharmacy regarding preferred drugs and biosimilars as required by pharmacy and or insurance company and notifies manager of changes.
Maintains log of missed prior authorizations and assists manager with monthly audit follow up for denials.
Collaborates with various hospital departments around billing, information management, policies, procedures and general operations related to prior authorizations.
Assists with training of new prior authorization staff and other duties as assigned.
Working Relationships:
This Job Reports To (Job Title): Manager, Prior Authorization Services, HHC Cancer Institute
