Advance Authorization Specialist- AH LC Cancer and Blood
2 months ago
Overview
Primary Purpose The Advanced Authorization Specialist is responsible for all aspects involved in obtaining highly complex authorizations for a multitude of In-patient and Out-patient Services. The Advanced Authorization Specialist must be knowledgeable and have a thorough understanding of Commercial and Government payors with regards to Coordination of Benefits, Authorization guidelines, Pharmacy and Medical Benefit variances, as well as Medical Necessity Policies. The Advanced Authorization Specialist is responsible for reading and interpreting various complex medical records to obtain authorizations for requested services and treatment plans. Communication with clinic staff, providers, Pharmacists, and insurance companies is essential to ensure completed peer reviews, relay updated medical and specialty drug policies, and appeals. They work closely with the Hospital and Provider Denial Management Teams to review monthly denials and assess opportunities for retro-active authorizations and determine root cause analysis.Major Responsibilities
- Assess time sensitive Referral Work Queues to obtain highly complex authorizations including IP/OP Chemotherapy, Radiology, specifically related to Oncology treatment plans, IP/OP Surgeries, Molecular and Genetic Laboratory Testing, specialty related PT/OT and Speech Therapy, Psychiatry, Neuro/Psych Evaluations, and Rehab evaluations.
- Manage high volume Stat request mailbox for all oncology facilities for potential life altering, high-cost treatment and procedures within a short time frame. Expected treatment within 1-3 days.
- Interpret medical records to determine initial and disease progression to prove medical necessity for ordered services and complete on-line clinical requests for advanced authorization.
- Manage Atrium Health preferred drug list (chemotherapy/immunotherapy/supportive drugs) with payors and correlate changes with oncology pharmacy.
- Manage Atrium Health drug formulary changes with authorization updates with payors.
- Review laboratory panels for Bone Marrow Biopsies to authorize Molecular Lab Studies, diagnosis specific.
- Review and address monthly denials for Chemotherapy Drugs, Molecular Labs and surgeries with payors and Atrium Health Denial Management Teams (HBO/PBO).
Minimum Job Requirements
Education
Bachelor's Degree or 3 years of authorization experience required.
Work Experience
Bachelor's Degree or 3 years of authorization experience required.Knowledge / Skills / Abilities
- General knowledge and background in CPT and HCPCS Coding.
- Must be proficient with medical terminology and be familiar with clinical considerations as these relate to oncology services.
- Excellent written and oral communication skills required.
- Microsoft Excel, Word, Epic experience preferred.
- Databases, hospital registration, billing and clinical systems preferred.
Physical Requirements and Working Conditions
- Work requires typing, filing, use of telephone and sitting for prolonged periods of time.
- Should be able to bend and lift up to 10lbs.
DISCLAIMER
All responsibilities and requirements are subject to possible modification to reasonably accommodate individuals with disabilities.
This job description in no way states or implies that these are the only responsibilities to be performed by an employee occupying this job or position. Employees must follow any other job-related instructions and perform any other job-related duties requested by their leaders.
-
Charlotte, United States Atrium Health Full timeOverview Primary Purpose The Advanced Authorization Specialist is responsible for all aspects involved in obtaining highly complex authorizations for a multitude of In-patient and Out-patient Services. The Advanced Authorization Specialist must be knowledgeable and have a thorough understanding of Commercial and Government payors with regards to...
-
CHARLOTTE, United States Atrium Health Full timeOverview Primary Purpose The Advanced Authorization Specialist is responsible for all aspects involved in obtaining highly complex authorizations for a multitude of In-patient and Out-patient Services. The Advanced Authorization Specialist must be knowledgeable and have a thorough understanding of Commercial and Government payors with regards to...
-
CHARLOTTE, United States Atrium Health Full timeOverview Primary Purpose The Advanced Authorization Specialist is responsible for all aspects involved in obtaining highly complex authorizations for a multitude of In-patient and Out-patient Services. The Advanced Authorization Specialist must be knowledgeable and have a thorough understanding of Commercial and Government payors with regards to...
-
CHARLOTTE , North Carolina ,, Mecklenburg County, NC, United States Atrium Health Full timeOverview Primary Purpose The Advanced Authorization Specialist is responsible for all aspects involved in obtaining highly complex authorizations for a multitude of In-patient and Out-patient Services. The Advanced Authorization Specialist must be knowledgeable and have a thorough understanding of Commercial and Government payors with regards to...
-
Charlotte, NC, United States Atrium Health Full timeOverview Primary Purpose The Advanced Authorization Specialist is responsible for all aspects involved in obtaining highly complex authorizations for a multitude of In-patient and Out-patient Services. The Advanced Authorization Specialist must be knowledgeable and have a thorough understanding of Commercial and Government payors with regards to...
-
Charlotte, NC, United States Atrium Health Full timeOverview Primary Purpose The Advanced Authorization Specialist is responsible for all aspects involved in obtaining highly complex authorizations for a multitude of In-patient and Out-patient Services. The Advanced Authorization Specialist must be knowledgeable and have a thorough understanding of Commercial and Government payors with regards to...
-
Charlotte, NC, United States Atrium Health Full timeOverview Primary Purpose The Advanced Authorization Specialist is responsible for all aspects involved in obtaining highly complex authorizations for a multitude of In-patient and Out-patient Services. The Advanced Authorization Specialist must be knowledgeable and have a thorough understanding of Commercial and Government payors with regards to...
-
Advance Authorization Specialist
3 weeks ago
Charlotte, United States Atrium Health Full timeOverview Primary Purpose The Advanced Authorization Specialist is responsible for all aspects involved in obtaining highly complex authorizations for a multitude of In-patient and Out-patient Services. The Advanced Authorization Specialist must be knowledgeable and have a thorough understanding of Commercial and Government payors with regards to...
-
Advance Authorization Specialist
1 month ago
CHARLOTTE, United States Atrium Health Full timeOverview Primary Purpose The Advanced Authorization Specialist is responsible for all aspects involved in obtaining highly complex authorizations for a multitude of In-patient and Out-patient Services. The Advanced Authorization Specialist must be knowledgeable and have a thorough understanding of Commercial and Government payors with regards to...
-
Advance Authorization Specialist
1 month ago
Charlotte, NC, United States Atrium Health Full timeOverview Primary Purpose The Advanced Authorization Specialist is responsible for all aspects involved in obtaining highly complex authorizations for a multitude of In-patient and Out-patient Services. The Advanced Authorization Specialist must be knowledgeable and have a thorough understanding of Commercial and Government payors with regards to...
-
Medical Assistant Specialist
7 days ago
Port Charlotte, Florida, United States Florida Cancer Specialists Full timeAt Florida Cancer Specialists, we prioritize our team members as the foundation of our organization's success. As a Medical Assistant Specialist in our cancer care unit, you will be part of a multidisciplinary team dedicated to delivering exceptional patient care.About Our OrganizationWe have built a national reputation for excellence since 1984, with over...
-
Charlotte, United States Atrium Health Full timeIf it’s possible, you will find it at Atrium Health—the third largest nonprofit healthcare system in the country. We invite Pediatric Hematologist to discover all that we can do when we bring healing hearts, inquisitive minds, and progressive visionaries together in our Levine Children’s Cancer & Blood Disorders Clinic.Levine Children’s...
-
Charlotte, United States Atrium Health Full timeIf it’s possible, you will find it at Atrium Health—the third largest nonprofit healthcare system in the country. We invite Pediatric Hematologist to discover all that we can do when we bring healing hearts, inquisitive minds, and progressive visionaries together in our Levine Children’s Cancer & Blood Disorders Clinic.Levine Children’s...
-
Cancer Specialist Opportunities in Charlotte
7 days ago
Charlotte, North Carolina, United States Atrium Health Full timeAtrium Health—a leading community-focused academic healthcare system—invites talented Hematology/Oncology physicians to contribute to our renowned team at the Levine Cancer Institute, serving the Greater Charlotte area.General Hematology/Oncology OpportunitiesWe offer a dynamic general hematology/oncology practice with opportunities to specialize in...
-
Cancer Care Medical Assistant
4 weeks ago
Port Charlotte, Florida, United States Florida Cancer Specialists Full timeAt Florida Cancer Specialists, our mission is to provide world-class cancer care to our patients. As a medical assistant, you will play a crucial role in assisting physicians with medical procedures, including phlebotomy, laboratory testing, quality control, instrument troubleshooting, and maintenance. We are committed to providing our patients with the best...
-
Charlotte, United States Atrium Health Full timeOverview If it's possible, you will find it at Atrium Health-the leading community-focused academic healthcare system serving North Carolina and South Carolina. We invite board- certified hematologist/oncologists to discover all that we can do when we bring healing hearts, inquisitive minds, and progressive visionaries together in our Hematology/Oncology...
-
Charlotte, North Carolina, United States Atrium Health Full timeAbout the OpportunityAtrium Health is seeking a board-eligible/board-certified Hematologist/Oncologist to join its team at Levine Cancer in Pineville, NC.As a member of our Hematology/Oncology team, you will have the opportunity to work with a talented group of healthcare professionals who are dedicated to providing exceptional patient care.About the...
-
Charlotte, United States Atrium Health Full timeIf its possible, you will find it at Atrium Healththe leading community-focused academic healthcare system serving North Carolina and South Carolina. We invite board- certified hematologist/oncologists to discover all that we can do when we bring healing hearts, inquisitive minds, and progressive visionaries together in our Hematology/Oncology team at...
-
Charlotte, United States Atrium Health Full timeIf its possible, you will find it at Atrium Healththe leading community-focused academic healthcare system serving North Carolina and South Carolina. We invite board- certified hematologist/oncologists to discover all that we can do when we bring healing hearts, inquisitive minds, and progressive visionaries together in our Hematology/Oncology team at...
-
Charlotte, United States Atrium Health Full timeIf it’s possible, you will find it at Atrium Health—the leading community-focused academic healthcare system serving North Carolina, South Carolina and Georgia. We invite experienced Hematology/Oncology APPs to discover all that we can do when we bring healing hearts, inquisitive minds and progressive visionaries together at our Ambulatory...
