Chemotherapy Insurance Authorization Specialist

Palo Verde Hematology Oncology LTD•Glendale, AZ

11d

About The Position

Position Summary: This position is responsible for obtaining benefits and prior authorizations for scheduled treatments/procedures. Responsible for educating patient on insurance coverage and benefits. Assess patients’ financial ability; may educate patient on assistance programs. Essential Duties and Responsibilities The essential functions include, but are not limited to the following: Prior to a patient receiving treatment; obtains insurance coverage information and demographics; educates patient on insurance coverage, benefits, co-pays, deductibles, and out-of-pocket expenses. Responsible for acquiring and documenting all Prior Authorizations need for patients before first visit. Assess patients’ ability to meet expenses and discusses payment arrangements. May educate patients on financial assistance programs as well as identify sources and provide assistance with completing forms. Based upon diagnosis, estimated insurance coverage, and financial assistance, completes Patient Cost Estimate form. Completes appropriate reimbursement and liability forms for patient’s review and signature. Forwards appropriate information and forms to billing office. Responsible for obtaining, from Clinical Reviewer, insurance pre-authorization or referral approval codes prior to each treatment. Review patient account balance and notify front desk of patients to meet with Ensure that patient co-pay amount is correctly entered into system (or conveyed), allowing front desk to collect appropriately At each patient visit, verifies and updates demographics and insurance coverage in computer system according to Standard Operating Procedures (SOPs). Stays current on available financial aid. Develops professional relationships with financial aid providers. Networks with financial aid providers to obtain leads to other aid programs. Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patient’s records. Maintains updated manuals, logs, forms, and documentation. Other duties as requested or assigned.

Requirements

Excellent computer skills. Must be able to work effectively with common office software and medical records software.
Requires the ability to perform basic math functions and to assemble data into reports using spreadsheet programs.
Must have the ability to handle confidential information and sensitive issues.
Must be able to work under minimal supervision and make independent decisions using good judgment.
Requires excellent communication, human relations, attention to detail and organizational skills.
Requires the ability to multi-task activities.
Must be able to communicate effectively to various ethnic and cultural backgrounds obtaining necessary resources when language barriers present.
Requires the ability to perform efficiently with some analytical/problem solving skills.
Ability to apply a common sense understanding to carry out detailed and involved written and/or oral instructions.
Ability to deal with problems involving occasional, last-minute changes in generally standardized situations.
High school diploma or a GED.
Six months related experience and / or training.
Knowledge of EMR, medical terminology, ICD-10 and CPT codes.

Responsibilities

Obtains insurance coverage information and demographics and educates patient on insurance coverage, benefits, co-pays, deductibles, and out-of-pocket expenses.
Acquires and documents all Prior Authorizations need for patients before first visit.
Assess patients’ ability to meet expenses and discusses payment arrangements.
Educate patients on financial assistance programs as well as identify sources and provide assistance with completing forms.
Completes Patient Cost Estimate form.
Completes appropriate reimbursement and liability forms for patient’s review and signature and forwards appropriate information and forms to billing office.
Obtains, from Clinical Reviewer, insurance pre-authorization or referral approval codes prior to each treatment.
Review patient account balance and notify front desk of patients to meet with
Ensure that patient co-pay amount is correctly entered into system (or conveyed), allowing front desk to collect appropriately
Verifies and updates demographics and insurance coverage in computer system according to Standard Operating Procedures (SOPs).
Stays current on available financial aid. Develops professional relationships with financial aid providers. Networks with financial aid providers to obtain leads to other aid programs.
Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patient’s records.
Maintains updated manuals, logs, forms, and documentation.
Other duties as requested or assigned.