Lead Finance and Authorization Specialist

SUMMARY

The primary responsibility of the Lead Finance and Authorization Specialist is 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 patients 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.

KEY RESPONSIBILITIES:

• Utilize appropriate insurance verification tools to validate patient insurance eligibility
• Generate timely patient estimates through the use of Rochester Regional Healths 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 providers 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

Lead Responsibilities:

• 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.

DESIRED ATTRIBUTES:

• 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.

MINIMUM QUALIFICATIONS:

• 1 to 3 years related work experience with billing functions preferably authorizations and verifications

EDUCATION:

LICENSES / CERTIFICATIONS:

PHYSICAL REQUIREMENTS:

Sedentary - Sedentary roles are primarily office-based and require prolonged sitting (67100% of the workday) with minimal physical effort and lifting limited to under 10 lbs. Fine motor skills are necessary for computer work writing and telephone use supported by clear visual and auditory ability. Cognitive and emotional demands are high due to extended concentration frequent interruptions independent decision-making and information processing. Although physical exposure is low administrative areas within healthcare environments may occasionally involve contact with infectious agents. Some roles may require flexible hours TB screening or a valid drivers license.

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 employees physician or delegate will be considered for accommodations.

PAY RANGE:

$19.00 - $25.00Rochester14625

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience relevant qualifications specialty internal equity location and contracts.

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.