Finance and Authorization Specialist - Lead

Finance And Authorization Specialist - Lead

The primary responsibility of the Lead Finance and Authorization Specialist is to be the subject matter expert and participate in the daily work related to the authorization and finance team. This includes the need 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.

Responsibilities

• 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 accurately schedule patients in accordance with the provider's orders.
• Communicate with other departments to address scheduling or authorization issues
• 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 in orientation of new staff
• Obtain referrals from payers that require it
• Obtain insurance information through various searches when not in the system
• Develop and implement training plan
• In collaboration with managers, provide leadership to the Finance and Authorization Specialists via staff meetings, huddles, and written communication.
• In collaboration with the managers, provide education to the front end staff.
• Identify and report trends as well as prior authorization and finance issues relating to billing and reimbursement
• Proactively manage and maintain all authorization accounts to increase billing of clean claims
• Complete other duties as assigned Oncology Specific
• Obtain prior-authorization on internal department orders for medications administered at oncology infusion locations; applicable to both new and established patients.
• 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 for requested products.
• Assist with research and resolution of denials as requested.

Required Qualifications

Preferred Qualifications

Education :

Licenses / Certifications :

Physical Requirements : S - Sedentary Work - Exerting up to 10 pounds of force occasionally 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.

Pay Range : $19.00 - $25.00

City : Rochester

Postal Code : 14625

Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.