This part time Prior Authorization specialist position is in our Hematology/oncology office in Framingham. Must have prior PA experience. Onc/Hem PA experience a plus.. EPIC knowledge a plus
Hours: Part time; 24 hours flexible
Principal Duties and Responsibilities:
Receive requests for Medical Oncology/Hematology pre-authorizations and ensure that they are properly and closely monitored
Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
Follow prior authorization work flow, policies and procedures
Collaborate with other departments to assist in obtaining pre-authorizations in a cross functional manner
Review accuracy and completeness of information requested and ensure that all supporting documents are present
Consult with supervisor or nurse manager to obtain clearance that treatment regimen is considered a medical necessity
Process referrals and submit medical records to insurance carriers to expedite prior authorization processes
Manage correspondence with insurance companies, physicians, specialists and patients as required
Look through denials and submit appeals in a bid to get them approved from insurance companies
Create patients’ records and accounts and ensure that pre-authorization information is properly updated in them
Secure patients’ demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPPA compliance and regulation
Benefits Package Highlights
Health Insurance: 90% of premium paid by CRMA for fulltime staff, prorated for part-time.
11 paid holidays/yr. 17 vacation/sick days/yr in addition. Prorated for part-time.
Dental, Vision, and Life available.
401k 4% contribution by CRMA
FSA/HSA available
