Drug Authorization Specialist at Dana-Farber… · Brookline

The Drug Authorization Specialist, with direct supervision of the Prior Authorization Supervisor, is responsible for managing all work related to drug authorizations for all injectable drug treatment plans ordered by Dana Farber Cancer Institute providers using knowledge of payer coverage policies and applies appropriate payer guidelines to all aspects of drug prior authorization work.

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.

• Manages referral and authorizations information as assigned through daily work queues and documents activities into the hospital information system; may require contacting physician offices and/or payors for referrals and authorizations via phone calls and/or websites
• Ensures accurate and timely responses to all referral requests
• Determines the pertinent clinical information needed to send to PCP and/or insurance office for approvals. Coordinates referral requests with PCPs and their practices, specialty practices, and with other clinical consultants as appropriate.
• Engages patients by telephone to discuss referral requests when necessary
• Verifies insurance eligibility and benefits using automated eligibility systems, payer websites, and calls to the insurance carriers; identify and resolve invalid insurance for patients and/or escalate patients as needed for Financial Counselor intervention
• Confirms, updates patient demographic, financial, and other relevant personal information into the hospital information system (EPIC)
• Communicates regularly with physicians and other medical providers regarding clinical clarifications for referrals and authorizations, medical necessity requirements, and facilitating conversations with different payers
• Documents daily activities in a timely, thorough, and accurate manner into the hospital information system
• Complies with all Dana-Farber and HIPAA confidentiality policies

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:

• Basic knowledge of insurance plans, medical registration or billing systems
• Basic knowledge of Epic or other hospital information systems
• Customer service and communication skills, both written and verbal
• Good judgment, tact, and sensitivity
• Relationship building skills and collaboration
• Proficient use of Microsoft office
• Ability to prioritize work and meet pre-determined deadlines, with direction
• Ability to work with sensitive patient information and maintain confidentiality

MINIMUM JOB QUALIFICATIONS:

• The position requires a high school diploma or GED, with a bachelor’s degree preferred. No prior experience is required.
• 1 year of customer service or hospital/physician office registration experience is preferred.

SUPERVISORY RESPONSIBILITIES: None

PATIENT CONTACT: Yes

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 committed to having faculty and staff who offer multifaceted experiences. Cancer knows no boundaries and when it comes to hiring the most dedicated and compassionate 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 characteristics protected by law.

EEO Poster

. Pay Transparency Statement

The hiring range is based on market pay structures, with individual salaries determined by factors such as business needs, market conditions, internal equity, and based on the candidate’s relevant experience, skills and qualifications.

For union positions, the pay range is determined by the Collective Bargaining Agreement (CBA).

$45,200.00 - $48,600.00