Job Description

Job Description

Job Description

Do you have experience in health care prior-authorizations of drugs and medications? Are you working in a retail pharmacy and looking for a change? Are you looking to work from home with company-provided equipment and an internet stipend? Do you want a good work-life balance with paid time off up to 3.5 weeks in your first year plus 10 paid company holidays? Do you take pride in knowing that you are making a difference every day in the lives of people with cancer and blood disorders? If you are then look no further than New England Cancer Specialists (NECS), a proud Dana Farber affiliate.

NECS is currently seeking a full-time 40 Monday-Friday remote Oral and IV Drug-Prior Authorization Specialist. Our Prior Authorization Specialists are responsible for acquiring insurance prior authorizations for all NECS patients, as directed through physician lead teams. This position makes substantial outbound calls to insurance companies and utilizes multiple insurance online payer portals to complete prior authorizations primarily for oncology and hematology treatments. The ideal candidate will be comfortable answering multi-line phone systems, triaging calls, resolving issues, and answering questions from patients and insurance companies. They will be able to take detailed messages and redirect / forward calls, as necessary. Our Prior Authorization Specialists maintain confidentiality, meet deadlines to advance patient care promptly, demonstrate superior customer service skills and the ability to be effective collaborators as well as function at elevated levels independently. NECS encourages Retail Pharmacy Tech's with Prior Authorizations experience to apply.

The ideal candidate will live within driving distance of our Westbrook Maine clinic. This position is primarily remote, but the ability to come on site is required.

NECS is a private medical practice composed of 18 oncologists and hematologists serving the region from five separate locations in Maine and New Hampshire. Our mission is to make life better for people with cancer and blood disorders. Kindness, compassion, and respect are part of everything that we do - from our phone operators to our physicians, every person on our team is important, and everyone makes a difference every day. We are proud to be the first Dana Farber Affiliate practice in the country, striving to provide the highest quality care and unmatched, holistic support for every patient, every day.

Job Duties :

• Complete prior authorizations for all tasked orders. Communicate clearly with physicians and physician-lead teams any issues or delays in the completion of tasks/authorizations.
• Documents clearly and accurately within the Electronic Medical Record
• Collect and submit all pertinent clinical information to insurance companies to ensure accurate authorization requests resulting in approvals.
• Check to ensure diagnosis supports treatment ordered and is covered per FDA and NCCN guidelines utilizing tools provided.
• Familiarize oneself and have a strong working knowledge of various insurance company's medical policies regarding specific medications.
• Work alongside the pharmacy department when new drugs are requested and or changed based on new criteria and or updated pricing strategies.
• Utilize various online portals/platforms to request and obtain accurate authorizations.
• Assist the billing office in the claim's appeals process when necessary.
• Communicates consistently and frequently with provider teams and Financial Advocates all changes to and or those issues which may affect a patient's overall care planning to ensure best outcomes for every patient.
• Returns all phone calls by the end of the same business day.
• Scans medical records according to NECS guidelines.
• Sorts and routes incoming mail and faxes for prior authorization department.
• Communicates clearly and professionally to patients and staff.
• Successfully maintain a pleasant, professional demeanor under stressful conditions.
• Other duties as assigned Financial Advocate Manager.

• High school diploma or GED required.
• Minimum one year in Medical Prior Authorizations required, with experience in oncology or specialty medicine preferred.
• Knowledge and application of medical terminology required.
• Previous experience with electronic medical record systems required.
• Exceptional customer service experience required.
• Retail Pharmacy experience preferred.

New England Cancer Specialists offers competitive pay and a comprehensive benefits package to our employees. Our benefits include medical, prescription, dental, and vision insurances. Company-paid Life Insurance, Short Term, and Long-Term disability insurances as well as Long Term Care insurance. Other benefits include a company-sponsored retirement program, generous Paid Time Off in addition to 10 Company-paid holidays, a Wellness Program, and other voluntary benefits.

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