Authorization and Oncology Services Specialist

5 days ago


Charlotte, North Carolina, United States Atrium Health Full time
Job Description:

The Authorization and Oncology Services Specialist plays a critical role in ensuring seamless authorization processes for complex oncology services at Atrium Health.

This position requires expertise in CPT and HCPCS coding, as well as a deep understanding of medical terminology and clinical considerations related to oncology services. The successful candidate will be responsible for interpreting medical records, determining initial and disease progression, and proving medical necessity for ordered services.

Key Responsibilities:
  • Assess time-sensitive referral work queues to obtain highly complex authorizations for IP/OP chemotherapy, radiology, surgeries, molecular and genetic laboratory testing, PT/OT, speech therapy, psychiatry, neuro/psych evaluations, and rehab evaluations.
  • Manage high-volume stat request mailboxes for oncology facilities, prioritizing life-altering, high-cost treatments and procedures within a short timeframe.
  • Interpret medical records to determine initial and disease progression, complete online clinical requests, and prove medical necessity for ordered services.
  • Collaborate with payors and the oncology pharmacy to manage Atrium Health's preferred drug list, correlating changes with authorization updates.
  • Review laboratory panels for bone marrow biopsies to authorize molecular lab studies, diagnosis-specific.
  • Address monthly denials for chemotherapy drugs, molecular labs, and surgeries with payors and Atrium Health's Denial Management Teams.
Requirements:
  • Bachelor's degree or 3 years of authorization experience required.
  • General knowledge of CPT and HCPCS coding, medical terminology, and clinical considerations related to oncology services.
  • Excellent written and oral communication skills.
  • Microsoft Excel, Word, Epic experience preferred.
Salary Range:

$70,000 - $90,000 per year, depending on experience.



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