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Position Summary:
We have an exciting opportunity to join our team as a Authorization Counselor - **Fertility Center**.

In this role, the successful candidate will be responsible for using demographic, insurance and medical information from Epic and existing EMRs together with existing patient schedules, reviews benefit plans and obtains prior authorization from par and non-par carriers related to fertility treatment and pharmaceutical protocols.

Job Responsibilities:

• Navigate insurance portals to obtain fertility benefit plans, verification/pre-authorization requirements.
• Performs other duties as assigned.
• Maintains cooperative and professional relationships with physicians, nurses, lab, office and billing staff. Cooperates with supervisor and all members of the team.
• Sends timely requests to referring physicians for information/clarification of plan
• Communicates those authorization cases denied for medical necessity or requiring peer-to-peer review to the referring physician/admin staff for clarification/ information/direction.
• Acts as a team resource regarding need for and process for authorization.
• Responds to patient inquiries, issues, and requests via email and telephone and on site in a timely and professional manner. Must be adept at relaying unexpected information to patients regarding fees and costs.
• Communicates to patients by telephone or email, decisions of the payor regarding authorization of treatment and pharma, including denials and pends. Documents all information in medical record and Epic.
• Documents updates related to authorization requirements by payer/employer group as requested- treatment requirements /pharma requirements.
• Recognizes non-conforming authorization decisions and brings to the attention of the authorization team lead and payor.
• Interacts with participating carriers and partner carriers {Progyny, Maven, Stork Club} to provide applicable information via completing forms or on line surveys to obtain authorization information medical history, treatment plan, Rx, etc.
• Adheres to schedules for ensuring authorizations are obtained and securely relayed to patients and clinical team members to ensure cycles can proceed without delay.
• Utilizes information from systems (EPIC & FERT & eIVF) to obtain anticipated treatment plans (including medication prescriptions) and translate treatment plan into necessary CPT codes in order to obtain authorization from carriers.

Minimum Qualifications:
To qualify you must have a High School Diploma
2 years relevant experience or the equivalent combination of education and experience.
Knowledge of insurance carriers procedures and policies, CPT codes and ICD10 codes

Preferred Qualifications:
Experience with insurance verifications or authorizations in a fertility practice
Knowledge of pharmaceutical and medical services available to fertility patients

Qualified candidates must be able to effectively communicate with all levels of the organization.

NYU Grossman School of Medicine provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents.

NYU Grossman School of Medicine is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sex, sexual orientation, transgender status, gender dysphoria, national origin, age, religion, disability, military and veteran status, marital or parental status, citizenship status, genetic information or any other factor which cannot lawfully be used as a basis for an employment decision. We require applications to be completed online.
If you wish to view NYU Grossman School of Medicine's EEO policies, please . Please to view the Federal "EEO is the law" poster or visit https://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm for more information.

NYU Langone Health provides a salary range to comply with the New York state Law on Salary Transparency in Job Advertisements. The salary range for the role is $41,977.18 - $55,000.00 Annually. Actual salaries depend on a variety of factors, including experience, specialty, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.

To view the Pay Transparency Notice, please