Authorization Specialist - Oncology and Hematology

Frederick Health•Frederick, MD

8d•$18 - $24•Onsite

About The Position

The Oncology and Hematology Authorization Specialist supports Frederick Health’s mission, vision, core values, customer service philosophy, and Compliance Program. The role monitors and obtains authorizations for phlebotomy, IV infusions, oral medications, radiology exams, and genetic testing. It also coordinates peer-to-peer reviews and generates appeals for chemotherapy and oral medication denials. The specialist communicates with patients, insurance carriers, practice staff, contracted payers, and the FMH finance department to secure the information and approvals needed. The role reviews physician orders for alignment with NCCN guidelines, helps patients access qualifying drug assistance programs, maintains confidentiality, and keeps current with payer rules and authorization processes. The position also requires maintaining knowledge of practice management software through vendor training and other education, assisting other work teams, and performing other duties as assigned. The work is performed in a normal business office. The position involves sedentary to light work, primarily sitting, with some walking or standing and infrequent lifting of up to 15 pounds. The role has no exposure to blood or body fluids.

Requirements

High school diploma.
Physician billing experience with working knowledge of professional fee billing transactions and regulations, claims, insurance carriers, rejection and denial codes, error correction and reposting, and contractual adjustments.
Prior experience and demonstrated competence with patient or customer information systems.
Ability to identify meaningful cause-and-effect situations related to professional fee claim rejections and denials.
Demonstrated competency with medical procedural coding, including CPT and ICD-10.
Excellent interpersonal skills, customer orientation, and ability to interact with personnel at all levels and work in a multidisciplinary team environment.
Excellent oral and written communication skills.
Professional manner and attire.
Ability to clearly articulate administrative processes for policy implementation.
Intermediate to extensive PC skills and ability to efficiently create, edit, and produce professional output using Microsoft Word, Excel, and PowerPoint.

Nice To Haves

College-level courses are preferred but not required.

Responsibilities

Monitor and obtain pre-authorizations for phlebotomy, IV infusions, oral medications, radiology exams, and genetic testing.
Monitor physician orders to ensure they meet NCCN guidelines.
Contact patients to obtain and review financial documents needed for qualifying drug assistance programs.
Maintain strict confidentiality in dealings involving patients, physicians, accounts, and fellow employees.
Communicate with insurance carriers, practice staff, and patients to obtain information needed for authorization.
Coordinate peer-to-peer reviews with third-party payers.
Generate appeals for chemotherapy denials.
Generate appeals for oral medication denials.
Interface with contracted payers and the FMH finance department.
Provide assistance to other work teams.
Maintain knowledge of payer rules, regulations, and authorization-process changes.
Maintain appropriate knowledge of practice management software through vendor training and third-party education.
Perform other duties as assigned.

Benefits

Health, dental, and vision insurance for eligible employees, effective the first of the month after 30 days of employment.
Employer-paid life insurance, short-term income replacement, and long-term disability for eligible employees.
Paid Time Off program for eligible employees.
403(b) retirement plan with an employer match for eligible employees.
Free financial planning sessions for all employees.
Educational assistance program.
Employer-paid Employee Assistance Program.

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