Prior Authorization Specialist/Insurance Reviewer - Clinical

The US Oncology Network•Eugene, OR

2d•Onsite

About The Position

In this role, you will help secure insurance authorizations for patient treatments, testing, and surgical procedures. By working closely with insurance companies and our care teams, you will help ensure patients can move forward with their recommended care without unnecessary delays. This position is ideal for someone who thrives in a fast-paced, high-volume environment and can successfully manage changing priorities while maintaining strong attention to detail.

Requirements

High school degree or equivalent.
Minimum three (3) years of prior authorization experience required.
Revenue cycle experience preferred.

Responsibilities

Reviews, processes and audits the medical necessity for treatments including radiation oncology, gynecologic surgery, genetic lab testing, imaging, and chemotherapy treatment for each patient. Documentation of regimen related to pathway adherence and payer guidelines.
Communicate with nursing, physician, pharmacists and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans. Provides prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered chemotherapy drugs.
Updates coding/payer guidelines for clinical staff. Tracks pathways and performs various other business office functions on an as needed basis.
Obtains insurance authorization and pre-certification for various oncology & hematology related services.
Maintains a good working knowledge of chemotherapy authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization. Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patient’s records.
Other duties as requested or assigned.