Chemotherapy Auth Specialist

The US Oncology Network•Orland Park, IL

2d•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 multi-disciplinary team of highly experienced caregivers focused on helping patients and their families receive the best care and support possible. SCOPE: Under general supervision verifies insurance eligibility, benefits, verification, prior authorization and researches denied services to ensure payments are processed on a timely basis. Acts as a liaison to ensure accurate processing of all claims. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards.

Requirements

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

Nice To Haves

Associates degree in Healthcare
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.
Works as a patient advocate and functions as a 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 and 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 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, 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.