Oncology Prior Authorization Specialist

JOB DESCRIPTION: Oncology Prior Authorization Specialist

REPORTS TO: Revenue Cycle Manager

JOB SUMMARY: Responsible for certifying and verifying insurance coverage . Obtains prior authorizations from insurance carriers for medical services within a designated time frame.

REQUIRED EDUCATION AND EXPERIENCE:

• High school diploma or equivalent

* 2\+ years of oncology pre\-authorization experience

• Knowledge and understanding of medical insurance benefits and coverages
• Knowledge of Medicare/CMS guidelines and NCCN
• Prior medical billing, coding or collections experience,
preferred not required

RESPONSIBILITIES:

Patient Services

• Verify all new, returning, and annual patient eligibility including private, government and third\-party insurance information within assigned territory or clinics
• Verify primary, secondary \& tertiary medical benefits and patient responsibility such as deductible, out of pocket, copay and coinsurance
• Inform and educate patients on their insurance benefits
• Obtain insurance authorization and pre\-certification and/or authorizations, specifically for chemotherapy services including treatment, labs and imaging
• Submit accurate pertinent demographic and supporting clinical documentation with pre\-authorization requests timely to avoid unnecessary delays in patient treatment
• Review, process, and audit the medical necessity for each chemotherapy treatment and documentation of regimen relative to pathway adherence and standards of care

* 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 functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays
• Submit patient medical data to insurance companies when requested

* Maintain strictest confidentiality; adheres to all HIPAA guidelines and regulations

• Protect patient confidentiality by making sure protected health information is secured by not leaving PHI in plain sight and logging off the computer before leaving it unattended

Administrative Support

• Answer questions from patients, clerical staff and insurance companies
• Participate in educational activities and attend monthly staff meetings
• Provide the highest level of customer service to patients, visitors, clinical staff and fellow employees. Adhere to customer service policies and standards as set forth by management at all times

Non\-essential Functions:

Performs basic word processing and utilizes computer programs as appropriate for duties.

Performs other non\-essential functions as requested.

Physical Demands:

Sitting: 90% Standing/Walking: 10%

Occasional lifting/carrying of supplies and patient related equipment weighing up to 30 pounds.

Occasional climbing of stairs to reach other levels of the building.

Occasional stooping/kneeling to access documents and supplies in lower cabinets.

Frequent reaching/handling/fingering to complete paperwork operate telephone and computer.

Constant talking/hearing/seeing to interact with patients, staff, physicians and visitors.

Job Type: Full\-time

Pay: $27\.00 \- $29\.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Experience:

• Insurance: 1 year (Preferred)
• Prior authorization: 1 year (Preferred)
• Medical Billing: 2 years (Preferred)

Work Location: Hybrid remote in Moscow, ID 83843