Prior Authorization Specialist -FT - McLeod Oncology & Hematology - Florence SC

McLeod Health • Florence, SC

5h

About The Position

Prior Authorization Specialist -FT - McLeod Oncology & Hematology - Florence SC

Founded in 1906, McLeod Health is a locally owned and managed, not for profit organization supported by the strength of more than 900 members on its medical staff and more than 2,900 licensed nurses. McLeod Health is also composed of approximately 15,000 team members and more than 90 physician practices throughout its 18-county service area. With seven hospitals, McLeod Health operates three Health and Fitness Centers, a Sports Medicine and Outpatient Rehabilitation Center, Hospice and Home Health Services. The system currently has 988 licensed beds, including Hospice and Behavioral Health. The hospitals within McLeod Health include: McLeod Regional Medical Center, McLeod Health Dillon, McLeod Health Loris, McLeod Health Seacoast, McLeod Health Cheraw, McLeod Health Clarendon and McLeod Behavioral Health.

If you would enjoy working in a dynamic environment and are looking for an opportunity to become part of a stellar team of professionals, we invite you to apply online today. We are an equal opportunity employer.

Requirements

• Knowledge of prior authorization process and its impact on the practice’s revenue cycle.
• Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively.
• Basic understanding of oncology treatment approaches and radiology studies as relating to diagnosis and restaging.
• Proficient use of J codes, CPT codes, ICD codes.
• High School/Ged

Responsibilities

• Works in with iPas system and monitors communications needs to assure timely management of prior authorization requests for all infusion services ordered through Florence and Seacoast Oncology and Hematology Offices.
• Review chart documentation to ensure patient meets medical policy guidelines and obtain authorizations via payer website or by phone.
• Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations.
• Respond to clinic questions regarding payer medical policy guidelines.
• Confirm accuracy of ICD diagnosis and corresponding J codes or CPT codes for orders
• Contact patients to discuss authorization status and obtain additional information as needed.
• Other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees