Pre-Access Oncology Specialist, 250 E. Liberty, 7:30a-4:30p

Job Description

The Pre-Access Oncology Specialist at UofL Health is responsible for verifying insurance, obtaining or verifying authorization, referrals, or precertification, checking medical necessity, referring concerns about patient estimates to financial clearance team, and coordinating patient orders.

Essential Functions

• Contact insurance plans/payers to determine eligibility and obtain coverage and benefit information.
• Pre-Access Oncology Specialists start cases over the phone, follow up, provide, and fax any clinical notes pertaining to the case to the insurance payors.
• Maintain consistent communication with payers, obtain any necessary referrals, treatment approvals for BMT, Med Oncology and Rad Oncology, and obtain approvals for Inpatient and Outpatient services.
• Obtain approvals for Inpatient and Outpatient services. Provide specifically requested information to payer to obtain approvals/authorizations; assist in the preparation of appeals for denials received from Med Oncology, Rad Oncology and/or Pharmacy.
• Document findings thoroughly and accurately and enter all authorizations that are obtained into billing system along with the correct ICD-10 and CPT code to ensure payment.
• Reviews 100% of all scheduled procedure orders for accuracy including physician signature, test/procedure to be performed, date and diagnosis, calls physician office to clarify order as needed, and indexes order to the account.
• Calls insurance payers to obtain, change or update approvals in a timely manner to take care of the patient.
• Participates in meetings (as appropriate) relating to coding, billing, reimbursement, denials, etc. for intravenous medications and infusions.
• Communicates medical updates effectively with payers and justify payment of services.
• Acquire authorization for Clinical Trials/Genotype and Foundation One. Follow up with pharmacy for drug replacement on denials and provide update of drug use.

Knowledge, Skills, and Abilities

• Must be dependable, professional and a team player.
• Must have critical thinking skills.
• Must have excellent organizational, oral & written communication skills.
• Must have ability to multi-task and be flexible with job demands.
• Must be energetic, motivated individual that connects well with people.