Chemotherapy Authorization Specialist

Virginia Oncology Associates is the largest group of medical professionals in Hampton Roads and Northeast North Carolina devoted exclusively to cancer care and blood disorders.

About the role

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, inventory control, obtaining insurance authorizations, researching patient financial assistance, and resolving denied services to ensure timely medication access.

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
• Communicates efficiently with patients and providers to overcome access barriers
• Obtains 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
• Communicates with medical staff regarding insurance restrictions, documentation requirements, or payer issues with non-covered chemotherapy drugs; reports problems or payer trends
• Processes insurance/patient correspondence, including denial follow-up, and maintains reimbursement correspondence and filing systems
• Acts as patient advocate and liaison between the patient, payer, specialty pharmacy, and patient assistance programs
• Counsels patients on insurance benefits and copayments; refers patients to assistance programs
• Maintains knowledge of chemotherapy authorization requirements for all payers, as well as state and federal regulatory guidelines
• Maintains relationships with specialty pharmacy contacts, drug reps, and patient assistance programs
• Uses prior authorization, specialty, and patient assistance portals
• Cross-trained to cover other retail/dispensary pharmacy technicians as needed
• Complies with patient confidentiality laws and regulations

Requirements

• High School diploma or equivalent
• Minimum 3-5 years of experience in a retail pharmacy setting
• Certified Pharmacy Technician certificate or State Pharmacy Board certification required
• Minimum two (2) years of 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 includes exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other conditions common to an oncology/hematology clinic. Regular exposure to direct patient contact, toxic substances, medicinal preparations, and chemotherapeutic agents.

Physical Demands

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. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.

Benefits

• Medical/Dental/Vision insurance
• Life insurance
• 401(k) retirement plan

Pay

Compensation range: $47,964.80 – $128,939.20. Actual compensation determined based on job-related factors such as relevant experience, education, certifications, licensure, and skills.

Employment Type: Full Time, In Person