At Charles River Medical Associates, we provide a work culture that is empowering. We encourage our team to be great and give their best each day. Our valued employees are the foundation of our success and are the key to fulfilling our mission. Charles River invests in employee learning and development and strives to promote within.
This Full Time Prior Authorization specialist position is in our Hematology/oncology office in Framingham. Working for a 2MD/1 NP office. Must have prior PA experience. Onc/Hem PA experience a plus. EPIC knowledge a plus!
Hours: 40 Hours M - Fr
- Receive requests for Medical Oncology/Hematology pre-authorizations and ensure that they are properly and closely monitored
- Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
- Follow prior authorization work flow, policies and procedures
- Collaborate with other departments to assist in obtaining pre-authorizations in a cross functional manner
- Review accuracy and completeness of information requested and ensure that all supporting documents are present
- Consult with supervisor or nurse manager to obtain clearance that treatment regimen is considered a medical necessity
- Process referrals and submit medical records to insurance carriers to expedite prior authorization processes
- Manage correspondence with insurance companies, physicians, specialists and patients as required
- Look through denials and submit appeals in a bid to get them approved from insurance companies
- Create patients’ records and accounts and ensure that pre-authorization information is properly updated in them
- Secure patients’ demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPPA compliance and regulation
- Health Insurance: 90% of premium paid by CRMA for fulltime staff, prorated for part-time.
- 11 paid holidays/yr. 17 vacation/sick days/yr in addition. Prorated for part-time.
- Dental, Vision, and Life available.
- 401k 4% contribution by CRMA
- FSA/HSA available
704935005
Job Type: Full-time