Overnight Prior Authorization Representative Express Scripts Jobs in Arizona

The Enterprise Transplant Financial Coordinator is an advanced level authorization representative with advanced knowledge of all solid organ and BMT pre-transplant and post-transplant processes.  The position has a thorough understanding of payer requirements related to referral, precertification, prior authorization and/or financial clearance.  

Courteously and professionally complete financial clearance calls works with patients to outline financial obligations related to care, and provides options for patients to meet financial requirements, including assessing financial assistance eligibility, determining insurance coverage eligibility, and providing estimates

Regularly monitor work queues to ensure authorizations are completed timely and escalate potential barriers or delays.

Answer and resolve inbound Transplant Call Center calls timely and efficiently.

This role requires interpretation of insurance coverage eligibility, insurance transplant contracts, and the submission of Letter of Agreement (LOA) and Individual Case Negotiation (ICN) requests to address any in/out of network coverage or self-pay issues.

This position may participate or provide information for in selection committee meetings with the Transplant Team from a financial aspect to assist the committee's decision to accept/deny potential transplant recipients and the determination of the patient's transplant listing status.

This role may also include participation and collaboration with a the multidisciplinary care team in the development and implementation of protocol and standards of care planned for the transplant patient.

This position will be responsible for monitoring and the updating of necessary documentation according to the United Network of Organ Sharing (UNOS) and Centers for Medicare and Medicaid Services (CMS) guidelines that may include listing, status changes and post-transplant follow up information.

Assist with staff training and cross coverage as needed.  

This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit's performance expectations.

Responsibilities include:

• Coordinating financial clearance for transplant-related services from intake through status determination
• Verifying insurance eligibility and interpreting transplant-specific benefits
• Initiating and supporting authorization and payer communication processes
• Communicating financial status, requirements, and next steps to internal teams
• Identifying barriers to financial clearance and taking appropriate action to resolve or escalate
• Maintaining accurate, detailed documentation to support continuity of work and compliance standards
• Following accounts through defined workflows to ensure completion of financial activities within scope
   

High School Diploma or GED and 5 years of experience in medical billing (hospital and/or professional), customer service and/or finance related field required.

Associate's degree or higher preferred.

Advanced knowledge of ICD-10, CPT coding required. Advanced knowledge of third-party payor referrals and authorizations required. 

Excellent written and grammatical skills, including proper phone etiquette. Advanced computer/keyboarding skills. Must maintain regular and acceptable attendance. Transplant financial counseling and billing experience preferred. Financial, analytical, and mathematical competencies preferred. Competence and experience with Epic preferred. Advanced knowledge of medical billing, reimbursement and collections processes preferred. Advanced knowledge of healthcare and transplant terminology preferred. Knowledge of insurance contracts and managed care experience preferred. Knowledge of solid organ transplants, bone marrow transplants (BMT), End Stage Renal Disease (ESRD), and Chimeric antigen receptor (CAR)-T cell therapy preferred. Knowledge of transplant billing requirements preferred. Knowledge of the Conditions of Participation (CoP), National Marrow Donor Program (NMDP), National Organ Procurement and Transplantation Network (OPTN), Scientific Registry of Transplant Recipients (SRTR), and all Federal Register's rules and regulations for organ acquisition preferred.  Certification Transplant Financial Coordinator (CTFC) preferred. Healthcare Financial Management Association (HFMA) Certification Preferred.

Preferred Qualifications

• Experience in financial counseling, insurance verification, authorization support, or revenue cycle operations
• Strong understanding of payer guidelines, benefits interpretation, and financial clearance processes
• Ability to manage a portfolio of patients/accounts and prioritize work effectively
• High attention to detail with strong documentation and follow-through skills
• Ability to communicate complex financial information clearly and professionally
• Experience working in transplant or high-complexity healthcare environments preferred

**This vacancy is not eligible for sponsorship / we will not sponsor or transfer visas for this position.  

During the selection process, you may participate in an OnDemand (pre-recorded) interview that you can complete at your convenience. During the OnDemand interview, a question will appear on your screen, and you will have time to consider each question before responding. You will have the opportunity to re-record your answer to each question - Mayo Clinic will only see the final recording. The complete interview will be reviewed by a Mayo Clinic staff member and you will be notified of next steps.