Prior Authorization Specialist - Network Exceptions

Basic Function and Scope of Responsibilities:

Assist with obtaining prior authorizations for IV chemotherapy and support medications ordered by physicians.

Principal Responsibilities:

• Works directly with the referral, billing, and nursing teams to obtain prior authorization for office visits for out-of-network coverage or network adequacy exceptions.
• Obtains authorization via fax, phone, or portal.
• Submit and/or obtain prior authorizations for urgent newly referred patients or follow-ups.
• Document steps of the process on order in EMR and Practice Management systems to allow others to follow status of the authorization.
• Answer calls from billing, nursing, physicians, and patients using exemplary customer service.
• Notify appropriate staff of authorization status in a timely fashion.
• Tracking authorization expiration dates to reauthorize patients for continued care.
• Following up with referring offices and payers if needed to get status updates for a submitted authorization.
• Serve as back up for Financial Counselors or Insurance Verification Specialist in times of absence.
• Perform other job-related duties as assigned.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

Education Requirements:

• Certified Medical Assistant (CMA) or Certified Nursing Assistant (CNA) certification preferred but not required.
• Prior experience obtaining prior authorizations preferred but not required.
• Prior experience in a medical office preferred but not required..

Performance Requirements:

Knowledge:

• Knowledge of principles and practices of prior authorization process in outpatient setting.
• Knowledge of EPIC orders and documentation.
• General knowledge of medical management of oncology patient.
• General knowledge of chemotherapy and appropriate use.

Skills and Abilities:

• Skill in exercising initiative, judgment, discretion and decision-making to complete job responsibilities.
• Skill in planning and organizing work to complete tasks in a timely manner.
• Strong verbal and written communication skills.
• Ability to be flexible in working with a team of prior authorization and nursing staff.
• Must have empathy and compassion during encounters with our oncology patients.

Working Conditions:

Physical surroundings: Medical office.

Adverse working environment Work may be stressful due to continual interaction with others, long hours required and nature of the medical specialty.

Physical Effort: Must possess the physical and mental abilities to perform the tasks normally associated with this role including prolonged sitting, walking, bending, standing, stooping and reaching. Lifting up to 15 pounds at times.

Local Travel: Occasional, within city limits only

Domestic/International Travel: None

Extensive Hours: None

The above statements are intended to describe the general nature and level of work being performed by persons assigned to this position. They are not intended to be an exhaustive list of all associated responsibilities, skills, efforts or working conditions. Mission Cancer + Blood, part of University of Iowa Health Care reserves the right to change, amend, add, delete, and otherwise assign any and all duties, responsibilities and position titles as it deems necessary to meet the needs of the business.

Mission Cancer + Blood, part of University of Iowa Health Care is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender, sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need.

In the interest of ensuring the safety of our employees, patients and community, Mission Cancer + Blood, part of University of Iowa Health Care has adopted a mandatory vaccination policy for COVID-19. All employees are required to be fully vaccinated against COVID-19 unless granted a reasonable accommodation for disability, religious or other extenuating circumstances. New employees will be granted a reasonable time to come into compliance with the policy, if necessary.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Ability to Commute:

• Des Moines, IA 50309 (Required)

Ability to Relocate:

• Des Moines, IA 50309: Relocate before starting work (Required)

Work Location: In person