Oncology Drug Authorization Specialist

1 week ago


Atlanta, Georgia, United States Medical Practice Full time
Job Summary

We are seeking a highly skilled and experienced Prior Authorization Specialist to join our Medical Practice team. As a Prior Authorization Specialist, you will play a critical role in ensuring that our patients receive the necessary coverage for their chemotherapy treatments.

Responsibilities
  • Obtain insurance authorization and pre-certification for chemotherapy services, as well as prior authorizations for drugs, surgeries, and services requiring insurance carrier prior authorization.
  • Review, process, and audit medical necessity for each patient's chemotherapy treatment and documentation of regimen relative to pathway adherence.
  • Interact with clinicians to ensure optimal treatment plans and maintain a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization.
  • Work as a patient advocate and function as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
  • Provide a contact list for patient's community resources, including special programs, drugs, and pharmaceutical supplies, and financial resources.
  • Adhere to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patient's records.
Requirements
  • 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 is helpful.
  • Prior experience with Centricity or other electronic medical records (EMR) is highly preferred.
Work Environment

This is a full-time position, working Monday to Friday. The ideal candidate will be a team player who is committed to providing excellent patient service and is proficient in medical billing and authorization procedures.



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