Full Job Description
Located in Manhattan, The New York Proton Center (NYPC) is one of the most unique and respected clinical partnerships in the world of proton therapy. The collaboration between Memorial Sloan Kettering Cancer Center, Montefiore Medical Center and Mount Sinai Health System brings state of the art proton therapy treatment to the patients of New York and the surrounding areas.
Our team at NYPC is comprised of highly motivated, passionate, professional and engaged individuals working together as a dynamic team to deliver an exceptional level of patient care, providing the most advanced proton therapy technology. We offer our employees a competitive compensation and benefits package with flexibility for growth and career advancement.
If you meet the criteria and would like to be a part of our collaborative, innovative and patient focused team, please apply with a cover letter and copy of your resume, or CV, to the current opportunity listed below.
The Prior Authorization Manager is responsible for the daily operation of the prior authorization / financial counselors department including business objectives, performance, and resource management. The Manager will oversee all functions of the financial counselor staff to ensure patients receive proper prior authorization before treatment, receive clear communication related to the status of their insurance authorization and to optimize New York Proton Center’s prior authorization performance. The person in this role will serve as the liaison to core services for financial clearance, staff training, quality assurance, analytics and performance improvement. The goal of this position is to ensure high quality service for patients and accuracy of information affecting pre-treatment services.
Duties and Responsibilities:
Manages Prior Authorization team in the processing of new patient referrals. Oversees and assists with the:
Verification of patient insurance benefits prior and during the patient life cycle
Procurement of prior authorizations including the timely completion and submission of appeals
Negotiates and procures of single case agreements
Monitors for missing and expired authorizations. Obtains extensions from the patient’s insurance carrier
Coordinates with patients on financial responsibility and assistance as needed
Maintains a working relationship with contracted billing organizations and relays important information as necessary to the NYPC leadership team.
Communicates and strategizes with dosimetry and physician team on comparison plans and various other requests
Maintains a solid understanding and knowledge of ERISA laws, regulations, and timelines as they relate to self-funded employer-sponsored insurance policies
Maintains a working knowledge of proton therapy clinical research developments
Participates in routine meetings with clinical leadership about ongoing clinical trials at the NYPC
Maintains a solid understanding and knowledge of payer requirements to maximize speed and timeliness of patient authorizations and approvals
Maintains a solid understanding and knowledge of local state laws, regulations, and timelines as they relate to fully-funded employer-sponsored insurance policies
Maintains knowledge of the various insurance carrier medical policies, keeps up to date on changes imposed by insurance carriers
Oversees communication among department members, referring physicians, and patients to ensure it is timely, professional, and consistent
Interviews, selects, recommends new hires. Trains and assigns duties to department team members. Provides direction and mentoring. Develops and communicates performance metrics to assess the effectiveness of team members, both as a department and individually
Evaluates performance and provide counseling, cross training, and coaching to team members
Establishes, communicates, and maintains operating policies and procedures and workflows to ensure compliance and the effectiveness and efficiency of operations within the department
Monitors results to evaluate compliance with quality and productivity indicators and identifies opportunities for improving results
Complies with all New York Proton Center policies related to Privacy Rules established under the Health Information Privacy and Portability Act of 1996 (HIPAA)
Performs other job-related duties as assigned
Bachelor’s degree required., clinical/healthcare administration degree preferred
Minimum five years of experience in patient care registration or general administrative/clerical experience in a healthcare setting. Radiation oncology experience preferred
Minimum of two years of supervisory or lead experience
Strong understanding of insurance verification and prior authorization fundamentals
Ability to analyze insurance coverage and benefits to inform patients of their coverage
Ability to maintain patient confidentiality at all times
Strong Microsoft Office experience desired
Exceptional communication skills required both verbal and written
The New York Proton Center (NYPC) strives to maintain a workplace that accepts and appreciates the differences among our employees. The company will not discriminate against any applicant or employee based on age, race, gender, color, religion, national origin, ancestry, disability, marital status, covered veteran status, sexual orientation, gender identity and/or expression, genetic information, status with respect to public assistance or any other characteristic protected by state, federal, or local law.