Authorization Specialist

The US Oncology Network•Greenwood Village, CO

14h•Onsite

About The Position

Rocky Mountain Cancer Centers (RMCC), Colorado's largest and most comprehensive provider of cancer care, is hiring an experienced Authorization Specialist in Greenwood Village, Colorado. The role supports patients by coordinating chemotherapy authorization and reimbursement matters, serving as a liaison between patients and payers, and working with clinical and business office staff. The position is performed in an office environment with frequent interaction with patients, staff, and payers. Candidates must pass a background check and a non-federal drug test, which excludes marijuana, after receiving an offer and before hire. Employees must show proof of influenza vaccination upon commencing employment; reasonable accommodations for exemptions will be considered case by case in accordance with applicable law. The posting remains open until an adequate applicant pool is identified, and early applications are encouraged.

Requirements

High school degree or equivalent.
At least two years of medical insurance verification and authorization experience.
Pass a background check and non-federal drug test, excluding marijuana, after offer and before hire.
Show proof of influenza vaccination upon commencing employment, subject to consideration of reasonable accommodations for exemptions under applicable law.

Nice To Haves

Billing and coding experience preferred.

Responsibilities

Review, process, and audit medical necessity for each patient's chemotherapy treatment and documentation of regimen and pathway adherence.
Act as a patient advocate and liaison between patients and payers, answer reimbursement inquiries, and help avoid insurance delays.
Obtain insurance authorization and precertification for chemotherapy services.
Research additional or alternative resources for non-covered services to prevent payment denials.
Provide patients with contact lists for community resources, including special programs, drugs and pharmaceutical supplies, and financial resources.
Communicate insurance plan restrictions and special requirements to nursing and medical staff.
Provide prompt feedback to physicians and management regarding pathway documentation issues and payer issues involving non-covered chemotherapy drugs.
Prepare and submit write-off requests with appropriate documentation.
Process insurance and patient correspondence, including denial follow-up, and maintain reimbursement correspondence and filing systems.
Review and process adjustments and refund requests.
Assist with review of financial disclosures and negotiated agreement adjustments.
Provide coverage for Patient Financial Counselors.
Report problems, issues, or payer trends.
Maintain working knowledge of chemotherapy authorization requirements for all payers and state and federal regulatory guidelines for coverage and authorization.
Comply with patient confidentiality laws and regulations.