What are the responsibilities and job description for the Insurance Verification Specialist position at TGH Cancer Institute (Cancer Center of South Florida)?
Insurance Authorization Specialist
Overview: Under the guidance of the Assistant Director of Pharmacy, the Pharmacy Services Coordinator plays a crucial role in managing pharmaceutical inventory and assessing the clinical and financial aspects of physician-prescribed treatments. This includes chemotherapy, immunotherapy, supportive IV therapy, and other oncology-related therapies. The Coordinator secures insurance approvals, educates patients on their benefits and copayments, assists in obtaining financial aid and grants, and provides necessary documentation to the Cancer Center of South Florida & Tampa General Hospital's Revenue Cycle Department. This position requires ongoing communication with patients, healthcare providers, nursing staff, and insurance companies.
Key Responsibilities:
- Conduct financial reviews of ordered IV therapies, considering drug costs and payer contracts.
- Perform clinical assessments of prescribed treatments based on payer guidelines, pathology reports, scans, lab results, prior treatments, and reputable sources like NCCN.
- Advise on white bagging and buy-and-bill strategies for TGH & CCSF teams in line with payer guidelines and financial evaluations.
- Obtain and document initial and subsequent pre-authorizations for services on all new and existing patients in the electronic medical record.
- Upload treatment documentation to the electronic medical record for the TGH & CCSF Revenue Cycle team.
- Communicate with patients and insurance companies about pre-certification processes and financial assistance options.
- Review patient chemotherapy protocols to assess insurance benefits and patient responsibilities.
- Schedule and conduct financial counseling calls, screen and enroll patients in financial assistance and drug programs.
- Apply for compassionate use drugs from pharmaceutical companies and follow up on shipment replacements.
- Document the financial counseling process in the electronic medical record and ensure necessary signatures are collected.
- Provide upfront estimates of patient financial responsibilities for treatments to facilitate copay, deductible, and coinsurance collections.
- Review chemotherapy schedules and follow up on outstanding claims with the CCSF or TGH Revenue Cycle department.
Additional Responsibilities:
- Collaborate with colleagues and leadership to meet business objectives.
- Participate in special projects as assigned.
- Maintain confidentiality and adhere to HIPAA guidelines.
- Demonstrate consistent attendance and punctuality.
- Comply with all personnel and operational policies.
Qualifications:
- Education: High school diploma or equivalent required.
- Experience: Minimum of 2 years in a related field, with experience in medical billing and collections.
- Skills: Strong knowledge of drug formulary and medical dosage calculations; familiarity with ICD-10 and CPT4 coding; excellent communication, analytical skills, and attention to detail.
Preferred Qualifications:
- Experience in oncology, radiation authorization, infusion authorization, and pharmacy authorization.
Required Experience
- Prior authorization experience.
Computer Skills:
- Proficient in Microsoft Office and basic internet applications; ability to enter data accurately and communicate via email.
Other Skills:
- Strong organizational, time management, and attention to detail.
- Effective interpersonal skills and experience with HIPAA compliance.
- Excellent verbal and written communication abilities.
- Team-oriented with a commitment to ethical practices and organizational support.
Physical Demands:
- Regularly required to use hands and arms; frequent standing, walking, and lifting (up to 25 pounds). Vision requirements include close and distance vision.
Work Environment:
- Moderate noise level; reasonable accommodations may be made for individuals with disabilities.
If you are a dedicated professional looking to make a meaningful impact in a dynamic healthcare environment, we encourage you to apply!
Job Type: Full-time
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Experience:
- Insurance verification: 3 years (Required)
- Pharmacy services: 2 years (Preferred)
Ability to Relocate:
- West Palm Beach, FL 33401: Relocate before starting work (Required)
Work Location: In person