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Prior Authorization Coordinator Job
Job Number: TMH16889
Job Title: Prior Authorization Coordinator
Department: CCC TMH Administration - 1102476
Facility: Rhode Island Hospital
Location: Providence, RI
High School diploma or equivalency required. Level of knowledge of business systems, office procedures, and computer database and basic computer skills normally acquired through completion of one year post-secondary business program, or the equivalent.
Possess strong medical terminology knowledge.
Strong organizational skills to effectively plan, direct and manage high volume of orders requiring prior authorization.
Interpersonal skills to train and coach staff and to demonstrate effective customer relations and communications with others within and outside the Hospital.
Analytical skills to evaluate effectiveness of work flow, make recommendations for change and to develop, review and evaluate various records and reports.
Ability to operate personal computer, including keyboard skills and familiarity with computer networks.
Clerical skills to demonstrate and/or perform activities with CCC staff and providers.
Ability to recognize and understand clinical documentation pertinent for obtaining prior authorizations.
Two years progressively responsible experience in health care with a heavy emphasis in one or more of the following areas: patient care environment, healthcare operations, database management, documentation and departmental operations. Knowledge of coding in a healthcare environment is a plus.
Excellent analytical and critical thinking skills and a focus for detail is needed.
Under the general supervision of the Business Manager, responsible for the integrity of each Comprehensive Cancer Center (CCC) location insurance prior authorization process. Coordinates and arranges for all for drug orders, chemotherapy infusions, Hem/Onc infusions, radiology orders, follow-up patient referrals, ensuring day hospital patient financial clearance from insurance companies have been received as well as possible trouble shooting as needed. Has a clear knowledge of Current Procedural Terminology (CPT), International Classification of Diseases (ICD), and registration information. Analyzes and provides process improvement updates and/or recommendations to the department manager.