Authorization Specialist - Oncology and Hematology

Frederick Health • Frederick, MD

10h

About The Position

The Oncology and Hematology Authorization Specialist supports Frederick Health’s mission, vision, core values, and customer service philosophy, and follows the FH Compliance Program, regulatory requirements, and Standards of Behavior. The position monitors and obtains pre-authorizations for phlebotomy, IV infusion, oral medications, radiology exams, and genetic testing; monitors physician orders for compliance with NCCN guidelines; generates appeals for chemotherapy and oral medication denials; and coordinates peer-to-peer reviews with third-party payers. The specialist also contacts patients to review financial documents for drug assistance programs and communicates with insurers, practice staff, patients, contracted payers, and the FMH finance department to secure authorization and resolve related matters.

The role maintains patient confidentiality and current knowledge of payer rules, regulations, authorization processes, and practice management software through ongoing training and education. The specialist may assist other work teams and perform other duties as assigned. The position involves patient contact with adolescents, adults, and geriatric patients. Work is performed in a normal business office and is classified as sedentary to light work, with occasional lifting up to 15 pounds and some walking or standing. The role has no exposure to blood or body fluids.

Requirements

• High school diploma.
• Physician billing experience with demonstrated 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 relationships 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 organizational levels and work in a multidisciplinary team.
• Excellent oral and written communication skills.
• Professional manner and attire.
• Ability to clearly explain administrative processes for policy implementation.
• Intermediate to extensive PC proficiency and ability to efficiently create, edit, and produce professional output using Microsoft Word, Excel, and PowerPoint.
• Ability to provide appropriate care or contact for adolescent, adult, and geriatric patients.

Nice To Haves

• College-level courses are preferred but not required.

Responsibilities

• Monitor and obtain pre-authorizations for phlebotomy, IV infusion, 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 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 and oral medication denials.
• Interface with contracted payers and the FMH finance department.
• Assist other work teams and perform other duties as assigned.
• Maintain knowledge of payer rules, regulations, and authorization-process changes.
• Maintain knowledge of practice management software through vendor training and third-party education.

Benefits

• Health, dental, and vision insurance beginning on the first of the month after 30 days of employment for employees hired to work at least 20 hours per week.
• Multiple insurance plans to meet employee and family needs.
• 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 employer match for eligible employees.
• Free financial planning sessions for all employees.
• Educational assistance program.
• Employer-paid Employee Assistance Program.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED