Chemotherapy Insurance Authorization Specialist

Palo Verde Hematology Oncology LTD•Phoenix, AZ

About The Position

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.

Requirements

Excellent computer skills. Must be able to work effectively with common office software and medical records software.
Ability to perform basic math functions and to 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 multi-task activities.
Ability to communicate effectively to various ethnic and cultural backgrounds obtaining necessary resources when language barriers present.
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 prior to a patient receiving treatment; educates patient on insurance coverage, benefits, co-pays, deductibles, and out-of-pocket expenses.
Acquires and documents all Prior Authorizations needed for patients before their first visit.
Assesses patients’ ability to meet expenses and discusses payment arrangements.
Educates patients on financial assistance programs, identifies sources, and provides assistance with completing forms.
Completes Patient Cost Estimate form based upon diagnosis, estimated insurance coverage, and financial assistance.
Completes appropriate reimbursement and liability forms for patient’s review and signature. Forwards appropriate information and forms to billing office.
Obtains, from Clinical Reviewer, insurance pre-authorization or referral approval codes prior to each treatment.
Reviews patient account balance and notifies front desk of patients to meet with.
Ensures that patient co-pay amount is correctly entered into the system (or conveyed), allowing the front desk to collect appropriately.
Verifies and updates demographics and insurance coverage in the computer system at each patient visit 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.
Performs other duties as requested or assigned.