Authorization counselor/ Hematology and Oncology

Job Summary

Maintains work queues for unauthorized and expiring medication-based referrals.

Responsibilities

• Verifies prior authorization requirements based on the patient’s specific insurance provider.
• Obtains clinical and treatment/therapy information from the patient’s chart.
• Sets up clinical documentation with prior authorization requests and tracks authorization status.
• Schedules peer-to-peer or appeal as needed.
• Documents authorization information in Epic EMR.
• Communicates insurance and facility preferred products and authorization status with providers, nursing team, pharmacy team, front desk, and MA team.
• Verifies insurance coverage, benefits, and network status.
• Provides patient cost estimates based on specific treatment protocol and patient benefits.
• Maintains schedule for self-pay patients and prepares estimates.
• Communicates the amount due at the time of service with the patient and patient service representatives.
• Coordinates patient care with third-party copay and free drug assistance vendors.
• Addresses patient and clinic billing questions and concerns, routing patient concerns to Revenue Management and Billing departments.
• Maintains good working knowledge of chemotherapy authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorizations.

Requirements

• Medical terminology
• Insurance eligibility and verification
• Minimum of 1 year health care experience
• Knowledge of ICD 10 and CPT coding
• Good customer service skills
• Computer skills and willingness to use technology
• Understanding of various hematologic and oncologic conditions and malignancies
• Understanding of treatments used to treat various oncologic and hematologic conditions
• Knowledge of registration and billing
• Epic knowledge

Qualifications

• Associate degree [Preferred]
• Bachelor's degree [Preferred]
• High School Diploma or equivalent [Required]
• Field of study: N/A
• Work experience: Eligibility, billing, coding, registration experience [Preferred]
• Health care or pharmaceutical experience [Preferred]
• Previous HBA experience [Preferred]

Skills

• Medical terminology
• Insurance eligibility and verification
• ICD 10 and CPT coding
• Customer service skills
• Computer skills
• Understanding of hematologic and oncologic conditions and malignancies
• Understanding of treatments used to treat various oncologic and hematologic conditions
• Knowledge of registration and billing
• Epic knowledge

Benefits

Includes medical, dental, vision insurance, life insurance, disability insurance, paid time off, 403-B retirement plan, mental health resources, and support, pet benefits, career development, whole person well-being resources, and more.

Pay

$21.19 - $33.90

Schedule

Full time, Day shift

Additional Information

For physical requirements, please refer to the link provided: Physical Requirements