Who We Are:

St. John’s Episcopal Hospital is the only hospital providing emergency and ambulatory care to the densely populated, culturally and economically diverse, and medically underserved populations of the Rockaways and Five Towns in southern Queens County and southwestern Nassau County, New York. Celebrating over 110 years of community care, the 257-bed facility provides people of all faiths with comprehensive preventive, diagnostic treatment and rehabilitative services, regardless of ability to pay.

Come Grow With Us!

Type: Full-Time (75 hours biweekly)

Shift: Days

Hours: 8:30 AM - 5:00 PM

Salary: $60,000 - $70,000

Job Summary:

The Eligibility/Authorization Specialist is responsible for securing prior authorization for chemotherapy infusions and related services. This role requires a deep understanding of insurance policies, medical terminology, and the prior authorization process. The Specialist will work closely with healthcare providers, patients, and insurance companies to ensure timely and accurate authorization for treatment.

Responsibilities:

• Prior Authorization:
  • Initiate and manage the prior authorization process for chemotherapy infusions and related services
  • Collect and submit required medical documentation to insurance companies
  • Follow up on pending authorizations and appeals
  • Maintain accurate and up-to-date records of authorization status
  • Collaborate with healthcare providers to obtain necessary clinical information
  • Identify potential authorization issues and develop strategies for resolution
• Insurance Verification:
  • Verify patient insurance eligibility and benefits for chemotherapy infusions
  • Determine coverage limitations, pre-certification requirements, and referral needs
  • Communicate insurance information to patients and healthcare providers
• Patient Communication:
  • Educate patients about the prior authorization process and required documentation
  • Answer patient questions regarding insurance coverage and financial responsibilities
  • Provide updates on authorization status and coordinate with patient care teams
• Data Management:
  • Maintain accurate and up-to-date patient records and insurance information
  • Utilize electronic health records and insurance verification systems
  • Prepare reports on authorization status and denial rates
• Compliance:
  • Adhere to all relevant federal and state regulations regarding prior authorization
  • Stay informed about changes in insurance policies and reimbursement guidelines
  • Participate in quality improvement initiatives to enhance the authorization process

Qualifications:

• High school diploma or equivalent required
• Medical billing certification preferred
• Oncology experience preferred
• Previous experience in healthcare or insurance industry preferred
• Strong understanding of medical terminology and insurance concepts
• Excellent communication and interpersonal skills
• Attention to detail and organizational abilities
• Proficient in computer applications, including electronic health records and insurance verification systems