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Now viewing: Precertification Analyst
HO
Highlands Oncology Group
Precertification Analyst
Job Description
Make a meaningful impact in the lives of cancer patients every day. As a Precertification Analyst, you play a critical role in helping patients access the treatments and services they need by navigating insurance requirements with accuracy, urgency, and compassion. Join our dedicated oncology team and become an essential advocate for patients during some of their most challenging moments. Highlands Oncology began in 1996 with three physicians and a desire to change the face of oncology care in our community. Dr. Malcolm Hayward, Dr. Dan Bradford, and Dr. Thad Beck knew that patients do better at home, in the community where they live and work, and where their support system is already in place. In furthering that goal, Highlands has grown with the region from a single location 26 years ago, to 6 locations in Northwest and Northcentral Arkansas today employing more than 800 diverse team members. As Northwest Arkansas continues to grow, so must the services and providers available in the region. Highlands Oncology is committed to remaining on the cutting edge to ensure our community has access to the very best cancer care. What we have is something quite unique right here in our own backyard with a caring multidisciplinary team focused on treating patients like family.
Answers and resolves incoming calls regarding STAT requests.
Prompt obtainment of authorization(s) for any urgent add-on requests.
Maintain accurate and current authorization(s) information in OncoEMR and G4.Work closely with imaging personnel to determine what date requires review to guarantee all authorizations are obtained in a timely manner.
Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with insurance plans.
Work closely with the insurance verification team to ensure insurance coverage is up to date.
Maintain a professional relationship with physician/nurses addressing questions, concerns regarding imaging orders/diagnoses.
Set up peer-to-peer review as requested.
Maintain a good working relationship with outside referring providers and staff.
Maintain patient/clinic confidentiality.
Ability to cover positions for Outside Treatments/Genetic Testing/In-patient Authorizations, as designated.
Maintain pleasant/helpful attitude towards patients and staff.
Perform all related duties as required by the Precertification Supervisor, Revenue Cycle Manager, and Business Office Director. Depending upon designation, your duties may vary as described below: Precertification Analyst - INFUSIONS Responsible for daily chemotherapy infusions/injections schedule. Will obtain prior authorizations for any treatments/drugs that require authorization. Will communicate with physician teams promptly should any issues arise with obtaining prior authorization.
Daily review of chemotherapy/infusion schedules and authorize any drugs/treatments that require authorization.
Work closely with Patient Assistance Representative to obtain drug replacement(s), as needed.
Maintain accurate and current authorization(s) information for chemotherapy/infusions in OncoEMR and g4. Precertification Analyst - OUTSIDE
Communicate closely with pharmacy to obtain up to date drug costs/changes to provide accurate price quotes.
Calculate cost analysis for ordered treatment and patient responsibility for each treatment after deductible/out of pocket. Once drug pricing done, forward to FC at treating location for them to adjust cost if pt receiving ANY financial assistance (pt assistance vs free drug program).Forward calculated amount owed by a patient for outside infusions/treatments to designated Financial Counselor at all Highlands facilities. Precertification Analyst - OUTSIDE
Works with patients, insurance companies, and clinical staff members.
Review of therapy and outside order schedules at all Highlands facilities daily to determine the insurances that require prior authorization for upcoming procedures/surgeries.
Communicate with nursing and medical staff to inform them of any restrictions or special requirements in accordance with insurance policies and guidelines.
Work on and maintain the outside order spreadsheet that is used for The Breast Center orders. Precertification Analyst - VA
Review of VA patients daily to determine coverage requiring prior authorization for upcoming services being provided to patients.
Work closely with VA personnel to determine what date requires review to guarantee all authorizations are obtained in a timely manner.
Communicate with nursing and medical staff to inform them of any restrictions or special requirements in accordance with specific VA coverage.
Work incoming VA referrals, expiring authorizations, outside VA orders, and consult requests as sent by the VA. Pre-Certification Analyst - SURGICAL
Review of surgery schedules for Highlands Oncology surgeons daily to determine the insurances that require prior authorization for upcoming procedures/surgeries.
Work closely with the surgical department and hospital personnel to determine what date requires review to guarantee all authorizations are obtained in a timely manner.
Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with specific insurance plans.
Work with surgical staff daily to ensure that requests are submitted timely to allow for insurance review. Precertification Analyst - IMAGING Fill out forms online or on paper; retrieves and submits records as needed to obtain authorizations.
Works with patients, insurance companies, and clinical staff members.
Review of imaging schedules at all Highlands facilities daily to determine the insurances that require prior authorization for imaging.
Work closely with imaging personnel to determine what date requires review to guarantee all authorizations are obtained in a timely manner.
Job Summary:
The Precertification Analyst for imaging services obtains prior authorizations for services as applicable. Fills out forms online or on paper; retrieves and submits records as needed to obtain authorizations. Works with patients, insurance companies, and clinical staff members. Job Duties /Responsibilities:
Review of imaging schedules for Benton County Clinic, North Hills Clinic, and Parkway Clinic daily to determine the insurances that require prior authorization for imaging.Answers and resolves incoming calls regarding STAT requests.
Prompt obtainment of authorization(s) for any urgent add-on requests.
Maintain accurate and current authorization(s) information in OncoEMR and G4.Work closely with imaging personnel to determine what date requires review to guarantee all authorizations are obtained in a timely manner.
Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with insurance plans.
Work closely with the insurance verification team to ensure insurance coverage is up to date.
Maintain a professional relationship with physician/nurses addressing questions, concerns regarding imaging orders/diagnoses.
Set up peer-to-peer review as requested.
Maintain a good working relationship with outside referring providers and staff.
Maintain patient/clinic confidentiality.
Ability to cover positions for Outside Treatments/Genetic Testing/In-patient Authorizations, as designated.
Maintain pleasant/helpful attitude towards patients and staff.
Perform all related duties as required by the Precertification Supervisor, Revenue Cycle Manager, and Business Office Director. Depending upon designation, your duties may vary as described below: Precertification Analyst - INFUSIONS Responsible for daily chemotherapy infusions/injections schedule. Will obtain prior authorizations for any treatments/drugs that require authorization. Will communicate with physician teams promptly should any issues arise with obtaining prior authorization.
Daily review of chemotherapy/infusion schedules and authorize any drugs/treatments that require authorization.
Work closely with Patient Assistance Representative to obtain drug replacement(s), as needed.
Maintain accurate and current authorization(s) information for chemotherapy/infusions in OncoEMR and g4. Precertification Analyst - OUTSIDE
INFUSIONS
Responsible for incoming outside infusion orders review. Will obtain prior authorizations for any treatments/drugs that require authorization. Will communicate with outside physician teams promptly should any issues arise with obtaining prior authorization.Communicate closely with pharmacy to obtain up to date drug costs/changes to provide accurate price quotes.
Calculate cost analysis for ordered treatment and patient responsibility for each treatment after deductible/out of pocket. Once drug pricing done, forward to FC at treating location for them to adjust cost if pt receiving ANY financial assistance (pt assistance vs free drug program).Forward calculated amount owed by a patient for outside infusions/treatments to designated Financial Counselor at all Highlands facilities. Precertification Analyst - OUTSIDE
ORDERS / THERAPY
Obtain prior authorizations for services as applicable. Fills out forms online or on paper; retrieves and submits records as needed to obtain/maintain authorizations.Works with patients, insurance companies, and clinical staff members.
Review of therapy and outside order schedules at all Highlands facilities daily to determine the insurances that require prior authorization for upcoming procedures/surgeries.
Communicate with nursing and medical staff to inform them of any restrictions or special requirements in accordance with insurance policies and guidelines.
Work on and maintain the outside order spreadsheet that is used for The Breast Center orders. Precertification Analyst - VA
SERVICES
Obtains prior authorizations for services as applicable. Fills out forms online or on paper; retrieves and submits records as needed to obtain/maintain authorizations. Works with patients, insurance companies, and clinical staff members.Review of VA patients daily to determine coverage requiring prior authorization for upcoming services being provided to patients.
Work closely with VA personnel to determine what date requires review to guarantee all authorizations are obtained in a timely manner.
Communicate with nursing and medical staff to inform them of any restrictions or special requirements in accordance with specific VA coverage.
Work incoming VA referrals, expiring authorizations, outside VA orders, and consult requests as sent by the VA. Pre-Certification Analyst - SURGICAL
ONCOLOGY
Obtains prior authorizations for services as applicable. Fill out forms online or on paper; retrieves and submits records as needed to obtain authorizations. Works with patients, insurance companies, and clinical staff members.Review of surgery schedules for Highlands Oncology surgeons daily to determine the insurances that require prior authorization for upcoming procedures/surgeries.
Work closely with the surgical department and hospital personnel to determine what date requires review to guarantee all authorizations are obtained in a timely manner.
Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with specific insurance plans.
Work with surgical staff daily to ensure that requests are submitted timely to allow for insurance review. Precertification Analyst - IMAGING Fill out forms online or on paper; retrieves and submits records as needed to obtain authorizations.
Works with patients, insurance companies, and clinical staff members.
Review of imaging schedules at all Highlands facilities daily to determine the insurances that require prior authorization for imaging.
Work closely with imaging personnel to determine what date requires review to guarantee all authorizations are obtained in a timely manner.