Precertification Specialist

The US Oncology Network•Teaneck Township, NJ

9d•Remote

About The Position

Join RCCA and make a meaningful impact on the patient journey. As a fully remote Precertification Specialist, you will be responsible for obtaining and managing prior authorizations to ensure patients receive timely access to the care and treatment they need. This role requires strong attention to detail, problem-solving skills, and a commitment to delivering exceptional service while navigating complex insurance requirements.

Requirements

High School diploma or equivalent required
Minimum two (2) years of experience in a patient access or financial clearance role. Oncology preferred.
Demonstrate advanced knowledge of medical terminology
Ability to navigate different systems seamlessly and able to multitask efficiently.
Must successfully complete required e-learning courses within 90 days of occupying position

Nice To Haves

Oncology experience preferred

Responsibilities

Ensuring that prior authorizations are obtained in a timely manner and remain current, facilitating uninterrupted patient care.
Reviews and confirms patient insurance eligibility, benefits, and coverage for specific services, ensuring alignment with payer requirements.
Follows standard operating procedures and established guidelines to complete tasks related to prior authorization, ensuring that all insurance requirements are met in a compliant and accurate manner.
Proactively follows up with insurance carriers on pending or denied authorizations, submitting appeals when necessary.
Resolves any issues or discrepancies related to prior authorization requests.
Supports and adheres to the US Oncology Compliance Program, including the Code of Ethics and Business Standards and US Oncology's Shared Values.
Monitors assigned worklists and emails to provide front-end review for authorization and to answer any questions related to authorizations.
Contacts patients to discuss OOP cost, offer assistance options (if available), and coordinate outreach for patient plan initiation (if applicable).
Reviews weekly denial report and resolves issues, including submitting retro authorization requests or front-end appeals.
Adheres to workflow and, if issues arise, escalates to Supervisor promptly.
Adheres to confidentiality and all state, federal, and HIPAA laws and guidelines regarding patient records.
Performs other duties as requested or assigned.