Medical Precertification Specialist

Key Responsibilities

• Evaluate requests for medical services, medications, and treatments, with a focus on oncology therapies, to ensure compliance with clinical guidelines and insurance requirements.
• Manage the authorization process for high-cost medications, chemotherapy regimens, and supportive treatments.
• Liaise with insurance companies to secure prior authorizations and resolve coverage issues.

Qualifications

• Licensure: Active and unrestricted LVN license.
• Experience: Minimum 1-2 years of clinical experience in a healthcare setting. Preferred: Previous experience with medication authorization, particularly for oncology treatments.
• Familiarity: Previous experience with oncology treatment protocols and medications, including chemotherapy, immunotherapy, and supportive medications.
• Knowledge: Strong understanding of medical terminology, oncology-specific treatments, and coding (CPT, ICD-10).
• Skills: Excellent analytical and problem-solving skills. Proficiency in electronic medical records (EMR) systems and Microsoft Office Suite. Strong interpersonal and communication skills, with the ability to explain complex information to patients and providers.