Authorization Specialist

Overview

Rocky Mountain Cancer Centers, Colorado's largest and most comprehensive provider of cancer care, seeks an experienced Authorization Specialist in Greenwood Village, CO. Our mission is to provide exceptional care to our patients, and we're looking for someone who shares our passion for making a difference.

Responsibilities

• Reviews, processes, and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen and pathway adherence.
• Works as a patient advocate and functions as a liaison between the patient and payer to answer routine and complex inquiries, reimbursement questions, and avoid insurance delays.
• Obtains insurance authorization and pre-certification for chemotherapy services. Researches additional or alternative resources for non-covered services to prevent payment denials.
• Provides a contact list for patients, community resources, including special programs, drugs, and pharmaceutical supplies, and financial resources.
• Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans.
• Provides prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered chemotherapy drugs.
• Prepares and submits write-off requests with appropriate documentation.
• Processes insurance/patient correspondence, including denial follow-up. Maintains reimbursement correspondence and filing systems.
• Reviews and processes adjustments and refund requests. Assists with review of financial disclosures and negotiated agreement adjustments.
• Provides coverage for Patient Financial Counselors. Reports any problems, issues, or payer trends.
• Maintains a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization.
• Complies with patient confidentiality laws and regulations.

Qualifications

• High school degree or equivalent.
• Minimum two (2) years medical insurance verification and authorization required.
• Billing and coding experience preferred.

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.
• Work is performed in an office environment and involves frequent interaction with patients, clinical and business office staff, and payers.

Salary Range

Salary Range: $18.29-$26.00 Pay is based on several factors including but not limited to education, work experience, certification, etc. As of the date of this posting, in addition to your salary, RMCC offers the following benefits for this position, subject to eligibility requirements:

• Health, dental, and vision plans;
• wellness program;
• health savings account;
• flexible spending accounts;
• 401(k) retirement plan;
• life insurance, short-term disability insurance;
• long-term disability insurance;
• Employee Assistance Program;
• PTO, holiday pay, tuition reimbursement, and employee paid critical illness and accident insurance.

Benefits

• Health, dental, and vision plans;
• wellness program;
• health savings account;
• flexible spending accounts;
• 401(k) retirement plan;
• life insurance, short-term disability insurance;
• long-term disability insurance;
• Employee Assistance Program;
• PTO, holiday pay, tuition reimbursement, and employee paid critical illness and accident insurance.

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.
• Work is performed in an office environment and involves frequent interaction with patients, clinical and business office staff, and payers.