Description

Job Schedule: Full Time
Standard Hours: 40
Job Shift: Shift 1
Shift Details: Monday - Friday

Work where every moment matters.

Every day, almost 30,000 Hartford HealthCare employees come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network. 

Hartford HealthCare Medical Group is one of the largest medical practices in New England with multiple locations throughout Connecticut and Rhode Island. We consist of a team of professionals ranging from Medical Assistants to Physician Assistants and everything in between. Our physician led medical group enjoys an excellent reputation with patients and the medical community, offering primary care, urgent care and more than 30 different specialties.

Job Description

Under the direction of the Manager, Prior Authorization Services, performs all clerical duties required to obtain insurance prior authorizations and other services in a timely manner.  Responsible for maintaining and managing resources, including insurance portal access, and provides consistent documentation in EPIC to support the obtained insurance authorization. Communicates changes in payer and or federal regulatory guidelines to their manager, pharmacy staff, providers and other clinical departments, as applicable. 

·        Monitors and reviews the prior authorization work queue daily to verify accuracy of patient’s insurance information and to interpret insurance pre-authorization requirements for scheduled chemotherapy treatments.

·        Contacts insurance companies to obtain prior authorization via telephone and/or portals and provides necessary clinical documentation to ensure authorization is obtained prior to the scheduled chemotherapy treatment.

·        Documents in EPIC prior authorization information obtained such as number of treatments authorized, length of time treatment is authorized, authorization numbers, and insurance company contact or call reference number.

·        Immediately communicates to provider and staff when a drug or plan is denied by the insurance company and communicates insurance company drug preference, if given.

·        Collaborates and communicates with pharmacy regarding preferred drugs and biosimilars as required by pharmacy and or insurance company and notifies manager of changes.

·        Maintains log of missed prior authorizations and assists manager with monthly audit follow up for denials.

·        Collaborates with various hospital departments around billing, information management, policies, procedures and general operations related to prior authorizations.

·        Assists with training of new prior authorization staff and other duties as assigned.

·        Travel required as needed to other office locations 

Qualifications

·        High School Graduate/Diploma preferred

·        At least one year experience working with insurances and prior authorizations, preferred

·        Experience and knowledge of insurances and prior authorizations

·        Ability to effectively and professionally communicate with physicians, clinical and administrative staff, managers, patients and insurance companies

·        Must be self-motivated and have the ability to work independently and within a team

·        Demonstrates excellent telephone, computer, organization and customer service skills

 

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge - helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.

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