Advance Authorization Specialist
About The Position
Assess time sensitive Referral Work Queues to obtain highly complex authorizations including IP/OP Chemotherapy, Radiology, specifically related to Oncology treatment plans, IP/OP Surgeries, Molecular and Genetic Laboratory Testing, specialty related PT/OT and Speech Therapy, Psychiatry, Neuro/Psych Evaluations, and Rehab evaluations. Manage high volume Stat request mailbox for all oncology facilities for potential life altering, high-cost treatment and procedures within a short time frame. Expected treatment within 1-3 days. Interpret medical records to determine initial and disease progression to prove medical necessity for ordered services and complete on-line clinical requests for advanced authorization. Manage Advocate Health preferred drug list (chemotherapy/immunotherapy/supportive drugs) with payors and correlate changes with oncology pharmacy. Manage Advocate Health drug formulary changes with authorization updates with payors. Review laboratory panels for Bone Marrow Biopsies to authorize Molecular Lab Studies, diagnosis specific. Review and address monthly denials for Chemotherapy Drugs, Molecular Labs and surgeries with payors and Advocate Health Denial Management Teams (HBO/PBO).
Requirements
- Bachelor's Degree or 3 years of authorization experience required.
- Bachelor's Degree or 3 years of authorization experience required.
- General knowledge and background in CPT and HCPCS Coding.
- Must be proficient with medical terminology and be familiar with clinical considerations as these relate to oncology services.
- Excellent written and oral communication skills required.
Nice To Haves
- Microsoft Excel, Word, Epic experience preferred.
- Databases, hospital registration, billing and clinical systems preferred.
Responsibilities
- Assess time sensitive Referral Work Queues to obtain highly complex authorizations including IP/OP Chemotherapy, Radiology, specifically related to Oncology treatment plans, IP/OP Surgeries, Molecular and Genetic Laboratory Testing, specialty related PT/OT and Speech Therapy, Psychiatry, Neuro/Psych Evaluations, and Rehab evaluations.
- Manage high volume Stat request mailbox for all oncology facilities for potential life altering, high-cost treatment and procedures within a short time frame. Expected treatment within 1-3 days.
- Interpret medical records to determine initial and disease progression to prove medical necessity for ordered services and complete on-line clinical requests for advanced authorization.
- Manage Advocate Health preferred drug list (chemotherapy/immunotherapy/supportive drugs) with payors and correlate changes with oncology pharmacy.
- Manage Advocate Health drug formulary changes with authorization updates with payors.
- Review laboratory panels for Bone Marrow Biopsies to authorize Molecular Lab Studies, diagnosis specific.
- Review and address monthly denials for Chemotherapy Drugs, Molecular Labs and surgeries with payors and Advocate Health Denial Management Teams (HBO/PBO).
Benefits
- Paid Time Off programs
- Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
- Flexible Spending Accounts for eligible health care and dependent care expenses
- Family benefits such as adoption assistance and paid parental leave
- Defined contribution retirement plans with employer match and other financial wellness programs
- Educational Assistance Program
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
