Reimbursement Specialist-Onc M

JOB SUMMARY

Responsible for coordinating the insurance authorization and pre-certification of scheduled medications and labs and communicating the denials as necessary.

DUTIES AND ESSENTIAL FUNCTIONS

Overall performance rating of below indicated essential job duties: Responsible for tracking, obtaining & extending authorizations in a timely manner. Records insurance information utilizing standardized documentation practices through the entire pre-cert/authorization process. Obtains, interprets & submits clinical documentation pertinent to the specific services requiring prior authorization to support reviews by the payer. Obtains & documents prior authorization approval from the insurance companies for services and communicates professionally and timely to the provider/clinical staff regarding authorization status or delays. Follows up on denied authorization requests. Facilitates peer-to peer conversations between the insurance carrier and the ordering provider when required to obtain authorizations for services. Provides support to other departments to clarify claim denial appeal efforts. May work to resolve claims denials related to the prior authorization process.

EDUCATION/LICENSE/CERTIFICATION/OTHER REQUIREMENTS

Minimum requirement: High School Diploma or GED Must type 35 words per minute Preferred qualifications: Knowledge of medications associated with infusion center

WORKING ENVIRONMENT

Works indoors in an office/clinic setting The noise level is usually moderate

PHYSICAL DEMANDS

Constantly required to maintain a stationary position behind a computer. Frequently required to move about inside the department. Constantly required to communicate telephonically and face to face with colleagues and customers. Constantly required to operate a computer and telephone. Constantly required to lift and/or move up to 10 pounds. Frequently required to lift and/or move up to 25 pounds. Occasionally required to lift and/or move up to 50 pounds Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, and depth perception