Overview:
Join Affiliated Oncologists as a Chemotherapy Auth Specialist!
AO specializes in treating a variety of cancers including lymphoma, lung, breast, prostate, gynecologic, colorectal, and head and neck cancers. Our physicians and staff are a multi-disciplinary team of highly experienced caregivers focused on helping patients and their families receive the best care and support possible.
SCOPE: Under general supervision, verifies insurance eligibility, benefits, verification, prior authorization, and researches denied services to ensure payments are processed on a timely basis. Acts as a liaison to ensure accurate processing of all claims. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards.
Responsibilities:
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Reviews, processes, and audits the medical necessity for each patient's chemotherapy treatment and documentation of regimen and pathway adherence.
- Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
- Obtains insurance authorization and pre-certification for chemotherapy services.
- Researches additional or alternative resources for non-covered services to prevent payment denials.
- Provides a contact list for patients' community resources including special programs, drugs, pharmaceutical supplies, and financial resources.
- Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans.
- Provides prompt feedback to physicians and management regarding pathway documentation issues and payer issues with non-covered chemotherapy drugs.
- Prepares and submits write-off requests with appropriate documentation.
- Maintains reimbursement correspondence and filing systems.
- Reviews and processes adjustments and refund requests.
- Assists with the review of financial disclosures and negotiated agreement adjustments.
- Provides coverage for Patient Financial Counselors. Reports any problems, issues, or payer trends.
- Maintains a good working knowledge of chemotherapy authorization requirements for all payers, State, and federal regulatory guidelines for coverage and authorization.
- Complies with patient confidentiality laws and regulations.
- Updates coding/payer guidelines for clinical staff. Tracks pathways and performs various other business office functions on an as-needed basis.
Qualifications:
MINIMUM QUALIFICATIONS:
- High school degree or equivalent.
- Associates degree in Healthcare.
- Minimum two (2) years medical insurance verification and authorization required.
- Billing and coding experience preferred.
- * LPN state license and registration 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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