Insurance Authorization Coord Lead

  • Exeter, NH
  • Exeter Hospital
  • Radiation Therapy
  • per diem standard
  • Req #: 9351
  •  Rotating Shifts - Per diem
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Summary

Oversees the daily operations for the oncology authorization team in both Medical and Radiation Oncology; including verifying, calling and obtaining authorizations.

 

Requirements:

  • 3 to 5 years in a medical setting
  • High School or GED
  • Strong customer service skills
  • Medical Terminology

Responsibilities:

  1. Oversee and coordinate the day-to-day operations and staff.
  2. Assist in hiring and training new authorization staff and provide performance feedback to Director.
  3. Responsible for being the liaison between both Medical and Radiation Oncology for obtaining prior authorizations for drugs as well as laboratory services and oral pharmaceuticals.
  4. Manage special projects such as our patient assistance program, which involves meeting with patients, reviewing programs and working as a liaison between the hospital and pharmaceutical companies.
  5. Develop and oversee criteria in Medical and Radiation Oncology for each major insurance company for chemotherapy drugs, labs and radiation modalities.
  6. Document and maintain all communications and insurance authorization information utilizing established systems.
  7. Responsible for the oversight of all Medicare LCDs and Commercial payer policies related to the combination of treatments to ensure medical necessity (this includes NThrive).
  8. Follow pre certification guidelines for each insurance company such as on line applications, faxing, telephone calls, etc.
  9. Coordinate the collaboration between providers, patient accounts, compliance team and manager to review protocol and assist with clarifying regulatory or policy questions.
  10. Update bench marking as needed.

Additional Information

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