Chemotherapy Insurance Authorization Specialist

Palo Verde Hematology Oncology LTD • Scottsdale, AZ

7d

About The Position

This position obtains insurance benefits and prior authorizations for scheduled treatments and procedures and educates patients about their insurance coverage and benefits. The specialist assesses patients’ ability to meet treatment-related expenses and may provide information about financial assistance programs.

The role verifies and updates patient demographics and insurance coverage, secures required authorization or referral codes before treatment, prepares cost estimates and reimbursement or liability forms, and forwards relevant information to the billing office. It also supports front-desk collections by ensuring co-pay amounts are entered or communicated correctly, maintains documentation, and complies with patient confidentiality and applicable laws and guidelines.

Requirements

• High school diploma or GED.
• Six months of related experience and/or training.
• Knowledge of EMR, medical terminology, ICD-10, and CPT codes.
• Excellent computer skills, including the ability to work with common office and medical-records software.
• Ability to perform basic math and assemble data into reports using spreadsheet programs.
• Ability to handle confidential information and sensitive issues.
• Ability to work under minimal supervision and make independent decisions using good judgment.
• Excellent communication, human relations, attention-to-detail, and organizational skills.
• Ability to multitask.
• Ability to communicate effectively with people from various ethnic and cultural backgrounds and obtain necessary resources when language barriers arise.
• Ability to work efficiently and use analytical and problem-solving skills.
• Ability to understand and follow detailed written and oral instructions using common sense.
• Ability to handle problems involving occasional last-minute changes in generally standardized situations.

Responsibilities

• Obtain insurance coverage information and patient demographics before treatment, and explain coverage, benefits, co-pays, deductibles, and out-of-pocket expenses.
• Acquire and document required prior authorizations before a patient’s first visit.
• Assess patients’ ability to meet expenses and discuss payment arrangements.
• Educate patients about financial assistance programs, identify potential sources of assistance, and help complete forms when appropriate.
• Complete Patient Cost Estimate forms based on diagnosis, estimated insurance coverage, and financial assistance.
• Complete reimbursement and liability forms for patient review and signature, and forward appropriate information and forms to the billing office.
• Obtain insurance pre-authorization or referral approval codes from the Clinical Reviewer before each treatment.
• Review patient account balances and notify the front desk when patients should meet with staff.
• Ensure patient co-pay amounts are entered into the system or communicated so the front desk can collect them appropriately.
• Verify and update patient demographics and insurance coverage in the computer system at each visit according to SOPs.
• Stay current on financial aid, develop professional relationships with financial aid providers, and network to identify other assistance programs.
• Protect patient-record confidentiality and comply with applicable state and federal laws and guidelines.
• Maintain current manuals, logs, forms, and documentation.
• Perform other duties as requested or assigned.

What This Job Offers

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