RN - Prior Authorization Specialist

JOB TITLE:

PRIOR AUTHORIZATION RN, (Chemotherapy, Infusions and Biologic medications for multiple clinics.)

HOURS & SHIFT REQUIREMENTS:
Full time. 40 hours weekly. Monday – Friday, 7:00 am – 3:30 pm or 8 am – 4:30 pm…Flexible schedule.

DEPARTMENT: PRIOR AUTHORIZATION DEPT.

To obtain prior authorization from multiple insurance companies before services are rendered for genetic lab testing, chemotherapy medications, infusion, and biologic medications, as needed. Prioritizing incoming prior authorization tasks in order of importance. Meet turnaround times for authorization guidelines. Arranging peer-to-peer cases for denied cases with providers. Collaborating with departments/clinics to ensure all medical documentation is received before submitting authorization as well as CPT coding information.

Initiates and completes the appeals process for denied services. Documentation, authorization, and progression of authorizations.

GIBSON AREA HOSPITAL & HEALTH SERVICES MISSION STATEMENT

To provide personalized, professional healthcare services to the residents of the Communities we serve.

Obtain prior authorization for genetic lab testing, chemotherapy, biologics, and infusion medications.

• Performs documentation responsibilities following all existing structure standards of the Prior Authorization Department. Demonstrates awareness and sensitivity to patient rights as identified within the institution.
• Functions with an awareness of and adherence to safety requirements as identified in existing standards.
• Demonstrates an awareness of self-responsibility and accountability for own professional practice within the Illinois Practice Act.
• Participates actively in staff development activities by sharing knowledge with others and using appropriate teaching/learning strategies to assist peers.
• Demonstrates self-directed learning and participation in continuing education to meet own professional development.
• Seeks validation of knowledge base, skill level, and decision making as necessary and assertively requests guidance in areas of question.
• Demonstrates effective organization and priority setting abilities in using self, human, and material resources in a time-oriented and cost-containment manner.
• Demonstrates effective verbal and written communication skills by implementing existing communication methods (i.e. staff meetings, communication boards, etc) and always attempting to receive and give information in a timely, concise, clear, and positive manner.
• Formulates and uses effective working relationships with all health care team members.
• Demonstrates appropriate use of lines of authority in clinical and operational matters when seeking direction, validating self-decision making, and resolving problematic issues.
• Remains flexible in staffing patterns and in resolution of staffing conflicts; participates in temporary assignment measures.
• Other duties as assigned.

• Requires sitting for long periods of time; also stooping, bending, and stretching for files and supplies. Occasionally lifts files or paper weighing up to 20 to 30 pounds.
• Requires manual dexterity sufficient to operate a keyboard, type at 40 wpm minimal, operate a calculator, telephone, copier, and such other office equipment as necessary.
• Vision must be correctable to 20/20, and hearing must be in the normal range for telephone contacts.
• It is necessary to view and type on computer screens for long periods and to work in an environment that can be very stressful.
• Auditory acuity to hear others for the purposed of fluent communication.
• Physical strength to perform the following lifting demands:
• Floor to waist – 20 pounds
• 14” to waist – 30 pounds
• Waist to shoulder – 20 pounds
• Shoulder to overhead – 10 pounds
• Carry 20 pound 30 feet
• Push 10 pound/force for 15 feet
• Pull 10 pounds/force for 15 feet

Reports to the Manager of the Prior Authorization Department