Drug Authorization Specialist


Drug Authorization Specialist

Job Details

Job ID:
26413

Location:
10 Brookline Place West, Brookline, MA 02445

Category:
Finance/Accounting

Employment Type:
Full time

Work Location:
Full Remote: 4-5 days remote/wk

Overview

Located in Boston and the surrounding communities, Dana-Farber Cancer Institute is a leader in life changing breakthroughs in cancer research and patient care. We are united in our mission of conquering cancer, HIV/AIDS and related diseases. We strive to create an inclusive, diverse, and equitable environment where we provide compassionate and comprehensive care to patients of all backgrounds, and design programs to promote public health particularly among high-risk and underserved populations. We conduct groundbreaking research that advances treatment, we educate tomorrow's physician/researchers, and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.

The Drug Authorization 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.

Requirements

  • Review and monitor the drug authorization workqueue, identifying patient treatment/therapy plans that require prior authorization.
  • Prepare and complete payer-specific prior authorization request forms, interpret medical policy criteria, and apply appropriate guidelines to prior authorization requests.
  • Review and comprehend patient progress notes, lab reports, infusion summaries, imaging reports, and plan of care. Identify appropriate medical documentation that satisfies payer medical policy criteria.
  • Determine when documentation does not meet medical policy guidelines and coordinate appropriate follow-up by clinical staff members that aid in the prior authorization process (e.g. prior authorization nurse review, physician peer-to-peers, and/or letters of medical necessity).
  • Follow-up with appropriate parties to meet all deadlines and prevent prior authorization denials.
  • Manage prior authorization process from initial submission to authorization for all assigned cases.
  • Manage prior authorization reports to ensure appropriate drug dispenses are appropriately authorized and followed-up on.
  • Monitor and report changes in payer prior authorization requirements.
  • Maintain detailed filing and archiving of prior authorizations to support post-claim denial workflows.
  • Independently monitors incoming drug prior authorization correspondences. Escalates high priority communications appropriately.
  • Update and maintain prior authorization tools and spreadsheets.
  • Orients and assists the training of new staff.
  • Completes assigned work, projects, and other duties as assigned.
  • 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

Qualifications

  • Bachelors degree
  • 1-3 years of equivalent work experience
  • Experience to include, but not limited to: healthcare/business administration, health insurance, medical policy/chart review, nursing, and/or other allied health fields.  Appropriate science and healthcare course work can be substituted
  • Knowledge of outpatient hospital revenue cycle workflows and systems
  • Must be detailed-oriented, independently prioritize workload, and manage time
  • Excellent communication skills - effectively interacts with all levels of staff and external contacts
  • Strong understanding of Microsoft Office product suite.
  • Epic experience preferred

At Dana-Farber Cancer Institute, we work every day to create an innovative, caring, and inclusive environment where every patient, family, and staff member feels they belong.  As relentless as we are in our mission to reduce the burden of cancer for all, we are equally committed to diversifying our faculty and staff.  Cancer knows no boundaries and when it comes to hiring the most dedicated and diverse professionals, neither do we. If working in this kind of organization inspires you, we encourage you to apply.

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.

Posted
11/21/2021
Salary Range
$34,000.00 - 55,000.00
per Year
Salary range estimated by
Location
Brookline, MA 02445, US
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