Coordinator - Infusion Authorization

Primary City/State:
Virtual
- Arizona

Category:
Patient Services,

Shift: Day, Department:
Clinical Authorization,

Work hours:

7:30am - 4:00pm

Under the direction of Leadership, performs Infusion/medication authorization functions for the hospital outpatient infusion departments (or other departments as assigned). Provides leadership critical information concerning outstanding authorizations, physician documentation and communication, nursing documentation and communication, and other information concerning outstanding authorizations. The position is responsible for denial prevention by obtaining authorizations and ensuring medical necessity is met each time the patient presents for infusion treatment, thereby protecting the organization's financial goals.

Works closely with Infusion staff, RN Auditors, Patient Financial Services, and Physician offices to minimize denials and obtain authorizations in a timely manner. This is a work-from-home position that may require staff to commute to NSSC for staff meetings and training. Staff are required to train/work from NSSC for the initial 6 months to 1 year as necessary to become proficient.

• Perform tasks related to the management of prior authorization for patients served by infusion clinics.
• Reviews medical records for submission to insurances, abstracting information from patient medical records pertaining to patient treatments, procedures, and guidelines as required.
• Review patient treatment plan including frequency and dosage, prior to treatment and reviews the applicable payer reimbursement criteria to ensure that the specific payer’s medical necessity criteria is met.
• Obtains approval, authorization and or predetermination for all chemotherapy and non‑chemotherapy infusion drugs administered in the Outpatient Hospital Infusion Center prior to treatment.
• Maintains professional working relationships with Honor Health employees at all levels.
• Communicates clearly, effectively, and respectfully with patients, physicians, infusion center staff and other personnel within the organization.
• Coordinates needs and updates manager.
• Provide results of the authorizations and or predeterminations.
• Communicates payer criteria to providers and or patients as requested.
• Provides formulary assistance for clinics through evaluating payer requirements.
• Serves as a subject matter expert for physicians, administrators, clinical staff, pharmacy staff and third‑party payers for issues regarding ambulatory reimbursement requirements and patient assistance programs.
• Uses appropriate communication etiquette with patients, physicians, all internal and external customers.
• Observes policies and procedures.
• Conducts outbound phone calls to patient and providers for patient support.
• Accepts inbound calls from patients and providers to provide support.
• Quickly and courteously responds to concerns from patients, staff, and others involved in patients care while maintaining a respectful demeanor.
• Facilitates problem solving with clinical departments, providers, referral sources, insurance companies and authorization staff.
• Assists in the maintenance and communication of changing payer and pharmaceutical information specific to coordination of patient needs, benefits and medical necessity.
• Files patient information received and records medical necessity requirements, in appropriate computer systems per department process and performs data entry of actions and responses to actions per department process.
• Enters complete and accurate notes regarding benefits, authorization, and predeterminations.
• Performs other duties as assigned.

• Bachelor's Degree
  - Preferred
• Associate's Degree or 2 years' work‑related experience in Healthcare Management or related field
  - Required

• 2 years experience obtaining authorizations for medical procedures/treatments including IV infusion of medications, chemotherapy or administration of biologicals or related experience
  - Required
• 4 years experience obtaining authorizations for medical procedures/treatments including IV infusion of medications, chemotherapy or administration of biologicals
  - Preferred

• Other CPC, CCS, or RHIT certification
  - Preferred
• Non Clinical/AZDL
  - Driver Licence
  - Valid And In State Current and valid State of Arizona driver’s license
  - Required