Authorization Specialist

The US Oncology Network•Greenwood Village, CO

5h•$18 - $26•Onsite

About The Position

Rocky Mountain Cancer Centers, Colorado's largest and most comprehensive provider of cancer care has an exciting opportunity for an experienced Authorization Specialist in Greenwood Village, CO to support or Oral Pharmacy Team. We realize that it sounds cliché but it is true - taking care of cancer patients is a calling. It’s much more than a job. Each of us has a unique story that brought us to Rocky Mountain Cancer Centers (RMCC), but those stories usually share common themes of care, compassion, and commitment. No matter the role each RMCC team member serves in, the goal is the same: to provide the best care possible for each and every one of our patients. Whether we are a nurse holding our patient’s hand, or a scheduler on the phone finding an appointment that fits into a patient’s schedule, we are deeply connected to our patients and do what we can to help. If this sounds like you, we’d love to have you join our team.

Requirements

High school degree or equivalent.
Minimum two (2) years medical insurance verification and authorization required.

Nice To Haves

Billing and coding experience preferred.

Responsibilities

Reviews, processes and audits the medical necessity for each patient 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 routine and complex inquires 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 and 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.
Processes insurance/patient correspondence, including denial follow-up. Maintains reimbursement correspondence and filing systems. Reviews and processes adjustments and refund requests. Assists with 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.