Authorization Specialist

US Oncology Inc.; Greenwood Village (CO); On-site; USD 25,000 - 36,000; Full time

Benefits offered by this job

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 and holiday pay

Tuition reimbursement

Employee paid critical illness and/or

Job summary

Rocky Mountain Cancer Centers in Greenwood Village, CO seeks an experienced Authorization Specialist to review medical necessity, obtain insurance authorization, and assure pathway adherence for chemotherapy services. The role interfaces with patients, payers, and clinical staff to prevent delays and ensure smooth financial workflows.

The position requires at least 2 years of insurance verification and authorization experience, with billing/coding background preferred.

Qualifications

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

Responsibilities

• Reviews, processes and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen and pathway adherence.
• Acts as patient advocate and liaison between patient and payer to answer routine and complex inquiries, obtain insurance authorization and pre-certification for chemotherapy services.
• Communicates with nursing and medical staff regarding restrictions or special requirements with insurance plans and provides feedback on documentation issues and payer concerns.
• Prepares and submits write-off requests with appropriate documentation.
• Processes insurance/patient correspondence, denials follow-up, adjustments and refunds, and covers Patient Financial Counselors as needed.
• Maintains knowledge of chemotherapy authorization requirements for all payers and adheres to confidentiality laws.

Skills

Insurance verification

Authorization

Communication

Patient advocacy

Education

High school diploma

Job description

Overview

Rocky Mountain Cancer Centers, Colorado's largest and most comprehensive provider of cancer care has an exciting opportunity for an experienced Authorization Specialist in Greenwood Village, CO.

We realize that it sounds cliché but it is true - taking care of cancer patients is a calling. It’s much more than a job. Each of us has a unique story that brought us to Rocky Mountain Cancer Centers (RMCC), but those stories usually share common themes of care, compassion, and commitment.

No matter the role each RMCC team member serves in, the goal is the same: to provide the best care possible for each and every one of our patients. Whether we are a nurse holding our patient’s hand, or a scheduler on the phone finding an appointment that fits into a patient’s schedule, we are deeply connected to our patients and do what we can to help.

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

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 inquires 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

MINIMUM 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. While performing the duties of this job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is occasionally required to stand, walk, and reach with hands and arms. The employee must occasionally lift and/or move up to 30 pounds. Requires vision and hearing corrected to normal ranges.

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.

All qualified candidates are required to pass a background check and non-federal drug test (which excludes marijuana) post offer of employment and prior to hire.

Candidates will be required to show proof of being vaccinated against influenza upon commencing employment. Reasonable accommodations will be considered on a case-by-case basis for exemptions to this requirement in accordance with applicable law.