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.
- 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
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).
$135,200.00 - $161,500.00
