Prior Authorization Coordinator Chemotherapy

The Oncology Institute•Cerritos, CA

29d•$21 - $22

About The Position

Founded in 2007, The Oncology Institute (NASDAQ: TOI) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. TOI offers cutting-edge, evidence-based cancer care to a population of approximately 1.9 million patients, including clinical trials, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With over 180 employed and affiliate clinicians and over 100 clinics and affiliate locations of care across five states and growing, TOI is changing oncology for the better. At The Oncology Institute of Hope and Innovation, every decision you make in chemotherapy authorizations directly impacts patient care. Your expertise ensures that patients receive timely, medically appropriate treatments while advancing our mission to deliver compassionate, state-of-the-art oncology care.

Requirements

Self-motivation and ability to work effectively in an independent environment
Comfortable working with patients who have cancer or a blood disorder
Experience on the payer side reviewing chemo authorizations submitted by the provider.
Attention to detail
Ability to learn new things quickly
Experience using EMR systems
Highly proficient in Microsoft Office particularly Excel, Word, and Outlook
Work well under deadlines and time pressures
Results-oriented with a focus on high quality
High school diploma or GED
CPT and ICD10 Knowledge
Medical Terminology
Insurance knowledge; PPO, HMO, Medi-Cal, Medicare, Workers Compensation

Nice To Haves

Experience performing, reviewing, or generating prior authorizations for procedure or chemotherapy specifically is preferred
Administrative experience in a physician office, clinic, hospital, or health insurance/ payer is a plus

Responsibilities

Coordinate with third-party insurance, clinical staff, and patients to effectively process prior authorization requests for Chemotherapy (IV and Oral), Hydration, IV injections.
Compile clinical documentation for prior authorizations (ex: progress notes, labs, diagnoses codes, previously tried therapies, doctor visits).
Review authorization queue for applicable orders
Verify and comply with payer contractual authorization requirements
Submit authorization request timely and efficiently, ensuring proper documentation is included for review
Utilize website portal, and electronic options to submit authorization requests
Submit verbal prescription orders approved by Provider and Medical Director to pharmacies, in conjunction with printed copy
Work with management to identify payer trends or potential issues
Demonstrate exceptional customer service skills in the performance of work assignments and duties
Perform special projects or other duties as assigned
Maintains confidentiality of patient records