A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.
Chemotherapy Authorization Specialist Virginia Oncology Associates - 3.3 Newport News, VA Job Details Full-time $47,964.80 - $128,939.20 a year 16 hours ago Benefits 401(k) Qualifications Retail pharmacy experience High school diploma or
GED Full Job Description Overview:
Virginia Oncology Associates, the largest group of medical professionals in Hampton Roads and Northeast North Carolina devoted exclusively to cancer care and blood disorders, has an exciting opportunity for a Pharmacy Tech Authorization Specialist for our offices in Newport News. •Please take this quick survey once you've submitted your resume to complete the application process: Pharmacy Tech Authorization Survey •If you have completed the survey before, even for another position, please do not take it again
Employment Type :
Full Time In Person Benefits :
M/D/V, Life Ins., 401(k)
Compensation Range:
$47,964.80 - $128,939.20. Actual compensation will be determined based on job-related factors such as, relevant experience, education, certifications, licensure, and skills that align with the role.
Responsibilities:
Under the supervision of a physician/pharmacist, provide in-office dispensing of oral drugs to oncology and hematology patients. This includes technical aspects of oral medication dispensing, record keeping and inventory control. Also, the tech will obtain insurance authorizations for oral medication, research additional or alternate resources for patient financial assistance, and research denied services to ensure patients receive medications on a timely basis.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Verifies patient demographics, insurance information and prescription information Processes prescription and bills insurance for payment Troubleshoots Medicare Part B verification requirements Demonstrates the ability to work independently and in a timely manner. Communicate efficiently with patients and providers to ensure access barriers are overcome. Obtain insurance prior authorizations for oral chemo drugs and retail pharmacy drugs Applies for financial assistance through cancer foundations, patient assistance programs and co-pay assistance for non-covered or high dollar oral drugs Communicate with medical staff to inform them of any restrictions or special requirements with insurance plans, and documentation or payer issues with non-covered chemotherapy drugs; report any problems or payer trends Process insurance/patient correspondence, including denial follow-up, and maintain reimbursement correspondence and filing systems Act as patient advocate and function as liaison between the patient, payer, specialty pharmacy, and patient assistant programs Counsels patients on insurance benefits and copayments. Refers appropriate patients to patient assistance programs Maintain a good working knowledge of chemotherapy authorization requirements for all payers, as well as state and federal regulatory guidelines for coverage and authorization Maintains beneficial relationships with specialty pharmacy contacts, drug reps and patient assistance programs Requires use of prior auth, specialty, and patient assistance portals Will be cross-trained to cover other retail/dispensary pharmacy technicians when needed Comply with patient confidentiality laws and regulations
Qualifications:
High School diploma or equivalent. Minimum 3-5 years of experience in a retail pharmacy setting. Certified Pharmacy Technician certificate or State Pharmacy Board required. Minimum two (2) years medical insurance verification/authorization and billing/coding experience preferred. Must be willing to travel to other office locations if needed.
WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. While performing the duties of this job, the employee is regularly exposed to direct contact with patients with potential for exposure to toxic substances, medicinal preparations, and chemotherapeutic agents.
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.
