Finance and Authorization Specialist

Job Title:

Finance and Authorization Specialist

Department:
Admin/Business Support

Location:

Lipson Cancer Institute – Rochester General
Hours Per Week:
Full‑Time

Schedule:

Day (M‑F)

The primary responsibility of the Finance and Authorization Specialist is to promptly verify patient’s insurance, obtain and verify if not provided, provide accurate patient estimate as requested, obtain or verify authorization for the procedures and treatments ordered by the department and ordering providers, and maintain communication to multiple departments with findings and issues.

• Utilize appropriate insurance verification tools to validate patient insurance eligibility
• Generate timely patient estimates through the use of Rochester Regional Health's Estimate Tool
• Support internal offices with generating estimates for future services, as requested
• Deliver Price Estimates to patients in a courteous and knowledgeable manner
• Deliver finalized estimate findings to patient via phone call, email, or MyCare channels
• Obtain prior‑authorization on both internal and external department orders for procedures/treatments performed in the department; applicable to both new and established patients.
• Coordinate with Patient Registration to appropriately and ventricularly schedule patients in accordance with the provider's orders.
• Communicate with other departments to address scheduling or authorization issues
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• Complete forms and letters to insurance for visit coverage
• Monitor daily schedules for add‑on appointments, insurance changes, and work accordingly within our policies to verify insurance, process estimates, and/or obtain authorizations.
• Monitor pending authorizations and follow due process should it need to be rescheduled
• Participate uni in orientation of new staff
• Obtain referrals from payers that require it
• Obtain insurance information through various searches when not in the system
• Complete other duties as assigned

• Obtain prior‑authorization on internal department orders for medications administered at oncology infusion locations; applicable to both new and established patients நின்.
• Review Oncology infusion orders for medical necessity per CMS, Manufacturer, or NCCN guidelines. Work with physicians if these specific guidelines are not met by documentation.
• Verify authorizations for non‑oncology patients for whom we have received medication administration orders.
• Communication to Oncology pharmacy of insurer preferred brands forորի requested products.
• Assist with research and resolution of denials as requested.

• Previous experience with insurance verification and benefit application, familiarity with ICD‑10 diagnosis, and procedure codes, and CPT/HCPCS codes.
• Proficiency in a variety of computer applications, spreadsheet applications, and common office equipment.
• Flexibility and ability to work as a team player
• Ability to handle simultaneous tasks paying great attention to detail
• Excellent communication skills including both oral and written as well as interpersonal skills.
• Excellent problem solving and follow through skills.
• Experience using EMR software
Additional basic computer skills required
• Excellent customer service and communication skills required.

• 2 years related work experience in a healthcare or insurance setting

None

Sedentary Work - Exerting up to 10 pounds of force occasionally्प Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements. Any physical requirements reported by a prospective employee and/or employee’s physician or delegate will be considered for accommodations.

$18.00 - $25.00

City:
Rochester

Postal Code: 14621