Chemotherapy Auth Specialist II

The US Oncology Network•Orland Park, IL

14h•Onsite

About The Position

Join Affiliated Oncologists as a Chemotherapy Auth Specialist! AO specializes in treating a variety of cancers including lymphoma lung, breast, prostate, gynecologic, colorectal and head and neck cancers. Our physicians and staff are a multi-disciplinary team of highly experienced caregivers focused on helping patients and their families receive the best care and support possible. Under general supervision, this role verifies insurance eligibility, benefits, and prior authorization, and researches denied services to ensure timely payments. The specialist acts as a liaison to ensure accurate processing of all claims and supports the US Oncology Compliance Program, including the Code of Ethics and Business Standards.

Requirements

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

Nice To Haves

Billing and coding experience preferred.
LPN state license and registration preferred.

Responsibilities

Reviews, processes, and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen and pathway adherence.
Acts as a patient advocate and liaison between the patient and payer to answer 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, 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 the 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, and State and federal regulatory guidelines for coverage and authorization.
Complies with patient confidentiality laws and regulations.
Updates coding/payer guidelines for clinical staff.
Tracks pathways and performs various other business office functions on an as-needed basis.