UMass Memorial Health is hiring a Prior Authorization Coordinator for Pharmacy Administration. In this 40-hour, day shift role, you will secure insurance authorizations, review requests for medical necessity, and determine appropriate benefit coverage for patients in our general and oncology infusion clinics.

What You'll Do

Complete prior authorization reviews for all general and oncology infusions, researching medical necessity based on patient diagnosis and treatment plans.
Work with multiple insurance carriers and vendors, staying current with policy changes related to authorizations.
Communicate with specific divisions, Insurance Verification, the Central Billing Office, and other departments regarding approvals, denials, and issue resolution.
Manage the 'Incoming Patient Report' to ensure appropriate prior authorizations are secured.
Manage all prior authorization renewals using appropriate databases and tracking tools to prevent lapses in medication coverage.
Coordinate the authorization process using defined best practices.
Participate in managing a shared database containing all prior authorization numbers, making edits as needed.
Assist in maintaining the Prior Authorization Best Practices manual, updating requirements from insurance carriers and recommending changes.
Perform weekly prior authorization audits to ensure accurate billing and resolve issues.
Produce required correspondence, reports, and memos.
Set up and maintain confidential files, records, and medical records, ensuring efficient information retrieval.
Ensure adequate inventory of office supplies and basic maintenance of office equipment.
Participate in performance improvement initiatives and demonstrate the use of quality improvement in daily operations.
Ensure compliance with health, safety, and regulatory agency requirements.
Comply with established departmental policies, procedures, and objectives.
Attend required meetings, conferences, and seminars.
Respect diverse views, demonstrate Standards of Respect, and contribute to a professional environment.
Maintain regular, reliable, and predictable attendance.

What We're Looking For

High School diploma.
2-3 years of medical secretarial or administrative support experience.
Proficiency in Microsoft Office and internet skills.
Good customer service skills.
Ability to work in a team environment.

Nice to Have

6-12 months of prior authorization experience in an infusion setting.
Prior experience using All Scripts or IDX.

Technical Stack

Microsoft Office
All Scripts
IDX

Benefits & Compensation

Compensation: $20.94 - $33.59 per hour.
A culture where Everyone Is a Caregiver, committed to exceptional patient care, academic excellence, and leading-edge research.
Our Standards of Respect: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player, and Be Kind.

Work Mode

This is an onsite position.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.