Authorization Specialist - Oncology and Hematology

Frederick Health•Frederick, MD

76d•Onsite

About The Position

Frederick Health is seeking a full-time Authorization Specialist for our Oncology and Hematology office. The Oncology and Hematology Authorization Specialist is responsible for monitoring, obtaining, pre-authorizing, generating appeals, coordinating peer-to-peer reviews for phlebotomy, IV infusion, oral medications, radiology exams, and genetic testing. This role supports the Frederick Health mission, vision, and core values, adhering to the FH Compliance Program and Standards of Behavior.

Requirements

Physician billing experience with demonstrated working knowledge of professional fee billing transactions and regulations, claims, insurance carriers, rejection and denial codes, error correction and re-posting, and contractual adjustments.
Completion of a high school diploma.
Prior experience and demonstrated competence with patient or customer information systems.
Must be able to define meaningful cause and effect situations related to professional fee claims rejections and denials.
Demonstrated competency with medical procedural coding (CPT/ICD10).
Must demonstrate excellent interpersonal skills, customer orientation, and the ability to interact with personnel of all levels within the organization and work within a multi-disciplinary team environment.
Excellent oral and written communication.
Professional manner and attire.
Ability to clearly articulate administrative processes for policy implementation.
Must be an intermediate to extensive PC user, and be able to maintain (create, edit, professional output) Microsoft Office products efficiently (Word, Excel, Power Point).

Nice To Haves

College level courses preferred but not required.

Responsibilities

Monitor and obtain all pre-authorizations for phlebotomy, IV Infusion, oral medication, radiology, and genetic testing.
Monitor physician orders to ensure they meet NCCN guidelines.
Initiate contact with patients to obtain and review necessary financial documents for qualifying drug assistance programs.
Maintain strict confidentiality in all dealings related to patients, physicians, accounts, and fellow employees.
Communicate with insurance carriers, practice staff, and patients to obtain information necessary 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 FMH finance department.
Provide assistance to other work teams.
Maintain knowledge of payer rules, regulations, and changes in the authorization process.
Maintain an appropriate level of knowledge of the practice management software through continuous vendor training and third-party education.