Pre-Certification Specialist

2 months ago

Knoxville, United States US Oncology Network-wide Career Opportunities Full time
Overview

We can't do it without YOU

Do you want to apply your experience, skills, and education to make a meaningful and lasting difference in the lives of our patients and their families? At Tennessee Cancer Specialists, it is the privilege of our employees to walk with our patients and their families as they move along the journey of fighting cancer. Whether you are working directly with patients in one of our clinics or a support role, you are an essential part of our mission to deliver the highest quality, compassionate care. Our 200+ employees make up the teams at our 16 different East Tennessee locations and have helped us achieve the Top Workplaces award two years running for the greater Knoxville area

As a Pre-Certification Specialist, you will assist our providers with obtaining prior authorization from various insurance carriers for ordered medications and treatments.

Here's what might happen on a typical day...

In this Monday - Friday role, you use your expertise to obtain authorization for patient treatments and break down barriers that might prevent that authorization. Your customer service skills will allow you to respectfully communicate with our payors, ensuring there is no delay in the patient's treatment plan. You will work alongside a team of dedicated individuals who will help you troubleshoot issues. As a point of contact for our clinic teams, you are responsible for fielding questions or assisting with additional needs.

While it can be challenging to balance the persistence needed to work with various payors and the empathy required for our patients, your professionalism allows you to do just that

Responsibilities

Experiences that matter...

  • Your knowledge of chemotherapy, immunotherapy, or other infusion treatment authorization requirements for all types of payors helps you stay ahead of the game when completing the pre-certification process
  • In conversations with patients, coworkers, and other providers, you provide exceptional customer service through communicating respectfully, thoroughly listening to all shared details, and asking any appropriate questions.
  • You can communicate and provide prompt feedback to physicians, management, and other clinical staff members regarding restrictions, special requirements, and other possible payor issues related to specific insurance plans
  • Maintaining a patient-focused mindset allows you to dig in and research alternative solutions to obtaining authorizations and recognize trends with specific treatments and payors
  • Your go-getter work ethic will have you ready to jump in and help out with any additional tasks.
Qualifications

We feel this position requires these basics:

  • A high school diploma or equivalent is required, but an associate's degree in a business-related field would be even better
  • Prior experience as a medical assistant or LPN will give you an edge.
  • Your proficiency with electronic health records, payor portals, and Microsoft Office (Outlook, Word, Excel, etc.) is a must.
  • Lastly, we feel that you will be most successful with at least one year of direct experience in a similar position (pre-certification, benefit financial counseling, benefits verification, referral specialist, medical assistant, LPN) to provide you with the background needed for this position.

MINIMUM QUALIFICATIONS: High school degree or equivalent. Associates degree in Healthcare * LPN state license and registration preferred. Minimum two (2) years medical insurance verification and authorization required. Billing and coding experience preferred.

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is occasionally required to stand, walk, and reach with hands and arms. The employee must occasionally lift and/or move up to 30 pounds. Requires vision and hearing corrected to normal ranges.

WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work is performed in an office environment and involves frequent interaction with patients, clinical and business office staff and payers.

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