Advance Authorization Specialist

2 days ago

Charlotte, United States Atrium Health Full time

Overview



Like the look of this opportunity Make sure to apply fast, as a high volume of applications is expected Scroll down to read the complete job description.

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



Bachelors Degree or 3 years of authorization experience required.



Work Experience



Bachelors 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.

  • Advance Authorization Specialist

    3 days ago

    Charlotte, United States Atrium Health Full time

    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...

  • Advance Authorization Specialist

    2 days ago

    Charlotte, United States Atrium Health Full time

    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...

  • Advance Authorization Specialist- AH LC Cancer and Blood

    2 days ago

    Charlotte, United States Atrium Health Full time

    Overview Read on to fully understand what this job requires in terms of skills and experience If you are a good match, make an application. 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...

  • Advance Authorization Specialist- AH LC Cancer and Blood

    2 days ago

    Charlotte, United States Atrium Health Full time

    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...

  • Advance Authorization Specialist- AH LC Cancer and Blood

    53 minutes ago

    Charlotte, United States Atrium Health Full time

    Overview Read on to fully understand what this job requires in terms of skills and experience If you are a good match, make an application. 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...

  • Advance Authorization Specialist

    2 days ago

    Charlotte, NC, United States Atrium Health Full time

    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...

  • Advance Authorization Specialist- AH LC Cancer and Blood

    3 hours ago

    Charlotte, United States Atrium Health Full time

    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...

  • Advance Authorization Specialist- AH LC Cancer and Blood

    3 days ago

    CHARLOTTE, United States Atrium Health Full time

    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...

  • Advance Authorization Specialist- AH LC Cancer and Blood

    3 days ago

    CHARLOTTE, United States Atrium Health Full time

    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...

  • Authorization Specialist

    2 days ago

    Charlotte, North Carolina, United States Atrium Health Full time

    Job Title: Advanced Authorization SpecialistJob Summary:Atrium Health is seeking an experienced Advanced Authorization Specialist to join our team. The successful candidate will be responsible for obtaining complex authorizations for in-patient and out-patient services, working closely with payors, providers, and hospital teams to ensure timely and accurate...

  • Advance Authorization Specialist- AH LC Cancer and Blood

    3 days ago

    CHARLOTTE , North Carolina ,, Mecklenburg County, NC, United States Atrium Health Full time

    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...

  • Authorization Specialist

    2 days ago

    Charlotte, North Carolina, United States Atrium Health Full time

    Job SummaryThe Advanced Authorization Specialist plays a critical role in ensuring timely and accurate authorization of complex medical services, particularly in oncology. This position requires a deep understanding of commercial and government payors, as well as expertise in medical terminology and coding.Key ResponsibilitiesAssess and prioritize...

  • Advance Authorization Specialist- AH LC Cancer and Blood

    3 days ago

    Charlotte, NC, United States Atrium Health Full time

    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...

  • Authorization Specialist I

    4 weeks ago

    Charlotte, United States BCforward Full time

    Authorization Specialist I BCforward is currently seeking a highly motivated Authorization Specialist I for an opportunity in Charlotte, NC 28206!Position Title: [Authorization Specialist I ] Location: [Charlotte, NC 28206- RemoteAnticipated Start Date: 09/16/2024 Please note this is the target date and is subject to change. BCforward will send official...

  • Eligibility Authorization Specialist

    4 months ago

    Port Charlotte, United States Millennium Physician Group Full time

    Job DescriptionJob DescriptionEligibility Authorization SpecialistFull Time (Monday-Friday 8AM-5PM)1777 Tamiami Trail, Port Charlotte, FLMillennium Physician Group is seeking to hire a full-time / Eligibility Authorization Specialist to join our Imaging Team. We are looking for a new team member who is positive, energetic and loves patient interaction. We...

  • Senior Authorization Coordinator

    3 weeks ago

    Charlotte, North Carolina, United States Atrium Health Full time

    Position Overview The Senior Authorization Coordinator plays a pivotal role in securing intricate authorizations for a diverse range of inpatient and outpatient services. This position demands a comprehensive understanding of both Commercial and Government payors, particularly in relation to Coordination of Benefits, Authorization protocols, Pharmacy and...

  • Clinical Nurse Specialist

    1 day ago

    Charlotte, North Carolina, United States destinationone Consulting Full time

    Job Title: Clinical Nurse SpecialistDestinationone Consulting is seeking a highly skilled Clinical Nurse Specialist to join our team. As a key member of our healthcare recruitment team, you will play a vital role in enhancing patient care and guiding nursing practices.Key Responsibilities:Provide advanced nursing care and expertise in your specialty area,...

  • Account Representative Authorized Dealer

    1 day ago

    Charlotte, North Carolina, United States New Age Marketing Inc Full time

    Job Title: Account Representative Authorized DealerWe are seeking a highly motivated and results-driven Account Representative Authorized Dealer to join our team at New Age Marketing Inc. As a key member of our sales team, you will be responsible for generating leads, closing sales, and providing exceptional customer service to our...

  • Advanced Quality Assurance Specialist

    1 week ago

    Charlotte, North Carolina, United States Columbus McKinnon Full time

    Job Summary:The Advanced Quality Assurance Specialist will assist in the development and operation of quality control systems, application and analysis of testing and inspection procedures, and the use of metrology and statistical methods to diagnose and correct improper quality control practices.Key Responsibilities:Formulates and maintains quality...

  • Advanced Wound Care Sales Specialist

    3 weeks ago

    Charlotte, North Carolina, United States Essity Higiene y Salud Mxico, S.A. de C.V Full time

    About EssityEssity is a global frontrunner in health and hygiene, with a commitment to enhancing well-being through innovative solutions. Our corporate headquarters are located in Stockholm, Sweden, while our North American operations are based in Philadelphia, PA. We are dedicated to breaking barriers to well-being through our diverse brands in Professional...