Prior Authorization Coordinator, Pharmacy Administration, 40hr, Day

Are you a current UMass Memorial Health caregiver Apply now through Workday.

Exemption Status : Non-Exempt

Hiring Range : $20.94 - $33.59

Please note that the final offer may vary within this range based on a candidates experience skills qualifications and internal equity considerations .

Schedule Details :

Monday through Friday

Scheduled Hours : 8AM-430P

Shift :

1 - Day Shift 8 Hours (United States of America)

Hours : 40

Cost Center :

10020 - 3851 Pharmacy Business Office

Union :

SHARE (State Healthcare and Research Employees)

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health everyone is a caregiver regardless of their title or responsibilities. Exceptional patient care academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts and a place where we can help you build the career you deserve. We are more than 20000 employees working together as one health system in a relentless pursuit of healing for our patients community and each other. And everyone in their own unique way plays an important part every day.

Obtains authorization numbers from insurance companies reviews all prior authorization requests for medical necessity and determines appropriate benefit coverage for all general and oncology infusion clinics supported by the Pharmacy Business office.

Major Responsibilities :

• Completes prior authorization review for all general and oncology infusions; researching medical necessity in reference to patient diagnosis and treatment plan utilizing appropriate compendiums and insurer policies.
• Works with multiple insurance carriers / vendors and keeps current with any and all changes as they relate to prior authorization.
• Communicates / interacts with specific divisions regarding approved or denied prior authorizations. Communicates with Insurance Verification the Central Billing Office and other Departments in order to resolve prior authorization issues.
• Manages the Incoming Patient Report ensuring appropriate Prior Authorizations are in place.
• Utilizing appropriate databases tracking mechanisms and tools manages all prior authorization renewals to assure no lapse in medication treatment coverage.
• Coordinates process for authorization using defined best practices.
• Participates in the management of a shared database which holds all prior authorization numbers and makes edits as needed.
• Assists in the maintenance of the Prior Authorization Best Practices manual which includes prior authorization requirement changes made by the insurance carriers and makes recommendations for changes.
• Performs weekly prior authorization audit to ensure accurate billing and resolves issues that arise.
• Produces correspondence reports memos etc. as required.
• Sets up and maintains confidential sensitive files and records for multiple functions academic materials medical records etc. ensuring efficient retrieval of information. Coordinates retrieval of medical records.
• Ensures adequate inventory of office supplies and basic maintenance of office equipment.
• Participates in performance improvement initiatives and demonstrates the use of quality improvement in daily operations.
• Ensures compliance with health and safety requirements and with regulatory agencies such as DPH etc.

Standard Staffing Level Responsibilities :

Position Qualifications :

License / Certification / Education :

Required :

Experience / Skills :

Required :

Preferred :

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.

Were striving to make respect a part of everything we do at UMass Memorial Health for our patients our community and each other. Our six Standards of Respect are : Acknowledge Listen Communicate Be Responsive Be a Team Player and Be Kind. If you share these Standards of Respect we hope you will join our team and help us make respect our standard for everyone every day.

As an equal opportunity and affirmative action employer UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race color religion gender sexual orientation national origin age disability gender identity and expression protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability please contact us at We will make every effort to respond to your request for disability assistance as soon as possible.

Required Experience :

IC

Key Skills

Internship,General Ledger Accounting,Communication,Healthcare IT,Fiber

Employment Type : Full-Time

Experience : years

Vacancy : 1

Monthly Salary Salary : 20 - 33