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Oncology Medical Practice Drug Authorization Specialist
2 months ago
_\*\*\*Opportunity for a hybrid schedule after demonstrated proficiency and performance\*\*\*_
Seeking a committed individual with prior Oncology experience to work with our doctors and patients to ensure coverage to continue to propel our organization in the right direction and celebrate successes…Come join our dedicated team in the fight against cancer
*RESPONSIBILITIES AND DUTIES:*
* Obtains insurance authorization and pre-certification and/or authorizations, specifically for chemotherapy services.
* Obtaining prior authorizations for drugs, surgeries and services requiring insurance carrier prior authorization and communicate with insurance payers for prior authorization approval.
* Reviews, processes, and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence.
* Interacts with the clinicians to ensure optimal treatment plans.
* Appeal insurance denials/rejections; assess accounts for completeness and accuracy.
* Maintains a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization.
* Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
* Provides a contact list for patient's community resources including special programs, drugs and pharmaceutical supplies and financial resources.
* Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patient's records.
Requires a minimum of 1-2 years medical insurance verification and authorization experience in an oncology setting. Experience with billing for Medicare, Medicaid and other third parties helpful. Prior experience with Centricity or other electronic medical records (EMR) highly preferred.
If you are committed to patient service and like being hands-on in several aspects of medical billing and would like to further develop your experience and skill set, it is encouraged to apply
Job Type: Full-time
Weekly day range:
* Monday to Friday
Job Type: Full-time
Work Location: In person
