Inpatient Authorization Specialist

Overview

Hybrid schedule: 2 weeks remote and 1 week onsite at Longwood Medical Center.

The Inpatient Authorization Specialist reports to and receives direction from the Access & Financial Engagement Supervisor to support inpatient registration and manage medical necessity-based authorizations for planned and urgent/emergent admissions to the Dana-Farber Inpatient Hospital. These functions include, but are not limited to, collecting demographic and insurance information, confirming insurance eligibility, verifying benefits, obtaining health plan authorizations for inpatient admissions, and denial management. In addition, the Inpatient Authorization Specialist is responsible for the timely and accurate completion of assigned work queues.

This role requires a commitment to service excellence, the ability to work in a fast-paced environment, and a knowledge of the overall financial policies and procedures at DFCI.

Located in Boston and the surrounding communities, Dana-Farber Cancer Institute is a leader in life changing breakthroughs in cancer research and patient care. We are united in our mission of conquering cancer, HIV/AIDS and related diseases. We strive to create an inclusive, diverse, and equitable environment where we provide compassionate and comprehensive care to patients of all backgrounds, and design programs to promote public health particularly among high-risk and underserved populations. We conduct groundbreaking research that advances treatment, we educate tomorrow's physician/researchers, and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.

Responsibilities

With direct supervision, the Inpatient Authorization Specialist:

• Reviews and monitors all inpatient authorization work queues.
• Independently identifies and prioritizes clinically urgent inpatient admissions and those with the greatest financial risk.
• Verifies insurance eligibility and benefits via automated eligibility systems, payer portals, or telephone communication.
• Produces high quality work under pressure.
• Reviews and comprehends patient clinical notes for submission of authorization requests.
• Manages complicated insurance coverage questions for patients, potentially working with the DFCI or Brigham and Women’s Hospital Financial Counselors.
• Informs providers and/or Case Management of medical necessity prior authorization denials or peer -to-peer review requests for prior authorization approval.
• Completes appropriate post-claim denial follow-up to overturn inpatient admission related prior authorization claim denials.
• Conducts in-person registration interviews with new patients and obtains appropriate patient signatures prior to their initial clinical visit. Verifies patient identification, confirm, and update the patient demographics, patient contacts, insurance information and PCP. Completes the Medicare Secondary Payer questionnaire with all Medicare Beneficiaries.
• Provides the patient with the following forms and obtains appropriate signatures: General consent for Inpatient treatment, HIPAA Notice of Privacy Policy, Important Message from Medicare, Patient Rights and Responsibilities, Plain Language Summary of Financial Assistance Policy, and Health Care Proxy.
• Prints the inpatient wristband, requests the patient verify all information on the wristband before securing it on the patient’s wrist. Provides for or escorts the patient to the Dana-Farber Inpatient Hospital.
• Updates changes to patient insurance and/or demographic information as needed.
• Implements downtime procedures during planned and unplanned system downtime events.
• Documents daily activities in a timely, thorough, and accurate manner in the hospital information system and department templates.
• Completes assigned work queues, projects, and other duties as directed.
• Promotes and maintains positive working relationships within the department, within the institute, with Brigham and Women and Boston Children’s Hospitals, and with the DFCI regional campus locations.
• Complies with all Dana-Farber and HIPAA confidentiality policies.
• Other duties as assigned, which may include other activities to support administrative activities for Dana-Farber Inpatient Hospital.
• Other duties as assigned, which may include other activities to support administrative activities for Dana-Farber Inpatient Hospital.
• Performs other duties as assigned.

Qualifications

• Minimum Education
  • High school diploma or GED required; Bachelor’s Degree preferred
• Minimum Experience
  • 1 year of relevant work experience, such as inpatient admissions or prior authorization experience required.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:

• Basic knowledge of insurance plans, medical registration or billing systems.
• Basic knowledge of Epic or other hospital information systems.
• Good customer service and communication, both written and verbal.
• Relationship building skills and collaboration.
• Analytics and problem-solving skills.
• Proficient use of Microsoft office.
• Ability to prioritize work and meet pre-determined deadlines with direction.
• Ability to work closely and effectively with colleagues across the organization and BWH including clinical staff.
• Ability to work with sensitive patient information and maintain confidentiality.
• Ability to use good judgment, tact, and sensitivity.

Pay Transparency Statement

The hiring range is based on market pay structures, with individual salaries determined by factors such as business needs, market conditions, internal equity, and based on the candidate’s relevant experience, skills and qualifications.

For union positions, the pay range is determined by the Collective Bargaining Agreement (CBA)

$24.27/hr - $26.68/hr

At Dana-Farber Cancer Institute, we work every day to create an innovative, caring, and inclusive environment where every patient, family, and staff member feels they belong. As relentless as we are in our mission to reduce the burden of cancer for all, we are equally committed to diversifying our faculty and staff. Cancer knows no boundaries and when it comes to hiring the most dedicated and diverse professionals, neither do we. If working in this kind of organization inspires you, we encourage you to apply.

Dana-Farber Cancer Institute is an equal opportunity employer and affirms the right of every qualified applicant to receive consideration for employment without regard to race, color, religion, sex, gender identity or expression, national origin, sexual orientation, genetic information, disability, age, ancestry, military service, protected veteran status, or other characteristics protected by law.