Drug Authorization Coordinator

Tennessee Oncology - Nashville, TN

Salary Grade: 114
Location: Nashville TN
FT/PT Status: Regular Full Time
Days: Monday - Friday
Hours: 40

Responsibilities / Essential Functions: Drug Authorization Coordinators are responsible for all administrative aspects of patient drug treatment benefit verification and authorization. Drug Authorization Coordinators function as a liaison between clinical staff, physicians and patient accounting making sure that Tennessee Oncology meets patient’s insurance requirements for reimbursement before treatment occurs while maintaining knowledge on drugs used to treat Tennessee Oncology patients. Communicate as needed with Patients on coverage that may affect their financial liability.

  • Obtains pre-authorizations for Physician Orders as required by the patient’s insurance carrier
  • Communicates with physician/clinical staff on reimbursement issues and/or pre-certification requirements by the patient’s insurance carriers
  • Communicates with physician/clinical staff concerning off label drug use
  • Coordinates and communicates information required or requested by Patient Accounting within the mandated timeframe.
  • Ensures up-to-date documentation on patient’s accounts in Electronic Medical Record and Patient Management on follow up or ongoing drug authorizations.
  • Keeps current on drug and insurance carrier requirements. Utilizing all sources available to stay abreast of drug information (indications, Pharma programs, pre-certification requirements etc)
  • Follows policy and procedures outlined by management to ensure standardization of processes across the clinics
  • Responsible for patient assistance coordination with the Patient Advocate and communicates with clinical staff to coordinate treatment plan requirements for indigent drug
  • Maintains continued authorizations of drugs ensuring that all treatment dates are covered for reimbursement.
  • Resolves items in task management related to drug authorization issues.
Knowledge, Skills & Abilities: •Excellent written and verbal communication skills with the ability to effectively communicate and establish collaborative relationships with physicians, patients, clinical and administrative staff, and the public.
  • Excellent customer service skills.
  • Knowledge of clinic office procedures, medical practice and medical terminology.
  • Ability to recognize, evaluate and solve problems.
  • Strong organizational skills and attention to detail.
  • Proficient in the use of end-user computer applications regarding productivity (MS Word, Excel, Outlook), database and patient scheduling and other medical information systems.
  • Ability to operate various types of office equipment.
Qualifications & Requirements: •High School diploma or equivalent required.
  • Medical insurance background
Physical Requirements: •Must be willing and able to lift up to 25 pounds.
  • Must be willing and able to travel to satellite clinics when necessary.