Authorization Specialist

OneOncology, LLC; United States; On-site; USD 42,000 - 64,000; Full time

Job summary

OneOncology, LLC is seeking an Authorization Specialist to manage outpatient diagnostic testing authorization and pre-certifications. You will verify insurance requirements, obtain pre-authorizations, and coordinate with physicians, patients, and billing staff to ensure timely approvals.

Candidates should have a high school diploma and at least one year of prior authorization experience; familiarity with payer guidelines and EMR systems is important.

Qualifications

• High School diploma or equivalent required.
• 1+ year of Prior Authorization experience preferred.
• Experience with medical insurance terminology and payer guidelines a plus.
• Proficiency in MS Office and EMR systems preferred.

Responsibilities

• Obtains pre-authorizations for diagnostic tests and procedures as required by insurance carriers.
• Verifies patient insurance requirements and reimbursement feasibility.
• Communicates with physicians, nurses, and billing staff to resolve authorization issues.
• Maintains up-to-date documentation in EMR/EBS for approvals and denials.
• Coordinates with hospital/diagnostic facilities for referrals and authorizations.
• Tracks and resolves denials and resubmissions; supports review and appeals as needed.
• Keeps current on payer requirements and policy changes.

Skills

Prior Authorization experience

Customer service

End-user computer applications

Communication

Education

High School diploma or equivalent

Tools

MS Word

Excel

Outlook

Job description

Authorization Specialist### Authorization SpecialistApply: United States: Full time: Posted Yesterday: R-0000026635OneOncology is positioning community oncologists to drive the future of medical care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer and other diseases. Our team is bringing together leaders to the market place to help drive OneOncology’s mission and vision.Why join us? This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, urology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of independent physicians and the patients they serve.**Job Description:****Role Summary:** The **Authorization Specialist** role is responsible for all administrative aspects of outpatient diagnostic testing and procedure benefit verification and authorization. This role will ensure patient’s insurance requirements for reimbursement before diagnostic testing or procedure. Obtains pre-authorizations for Physician Orders for diagnostic testing or procedure as required by the patient’s insurance carrier. Ensure the financial feasibility of treating each patient in our clinics by communicating and working closely with patients, physician, nurse and social worker. Work in specific areas of concern in the department on a project basis. Assist Patient Finance Manager in training staff, projects and implementations. Maintain in-depth knowledge of authorization process as well as reimbursement methodologies. Maintain knowledge of collection techniques and collection laws. **Responsibilities:*** Obtains pre-authorizations for Physician Orders for diagnostic testing or procedure as required by the patient’s insurance carrier.* Communicates with physician/clinical staff on reimbursement issues and/or pre-certification requirements by the patient’s insurance carriers.* Ensures up-to-date documentation on patient’s accounts in Electronic Medical Record on authorization approvals and denials.* Communicates with Insurance Authorization Coordinators the need for updated referrals.* Communicates with front office manager and staff in the case of denials that will require rescheduling and/or peer-to-peer review by the ordering physician.* Communicates with hospitals or other diagnostic facilities to correct any discrepancies.* Contacts Insurance Authorization Coordinators to notify of termed insurances.* Communicates as necessary and in a timely fashion with Front Office and imaging center staff with regards to the status of pending authorizations.* Contacts Clinical Trial team to notify of denied scans for patients on study to verify coverage of scan by study.* Keeps current on insurance carrier requirements for diagnostic testing and procedures.* Follows policy and procedures outlined by management to ensure standardization of processes across the clinics.* Additional responsibilities may be assigned to help drive our mission of improving the lives of everyone living with cancer.* Lab Information System, Pharmacy Information System, Entire Chart/Electronic Medical Record (EMR), Electronic Billing System (EBS).* Works denial worklist completing retro authorization request and or medically necessary appeals.* Review payer guidelines for medically necessity guidelines including frequency and prior testing requirements. **Required Qualifications:****EDUCATION & EXPERIENCE:*** High School diploma or equivalent.* 1+ year(s) of Prior Authorization experience, urology authorization experience highly preferred.* Medical insurance background required. **Essential Competencies:*** Attendance is an essential job function.* Ability to work effectively with all levels of management and other colleagues* Ability to demonstrate initiative and mature judgment.* Ability to demonstrate high degree of professionalism and adaptability.* Ability to demonstrate proficiency in the use of end-user computer applications (MS work, Excel, Outlook), database and patient scheduling and other medical information systems.* Ability to demonstrate strong customer service delivery skills.* Ability to utilize websites, portal and electronic options when available to increase efficiency* Ability to follow oral and written instructions.* Ability to recognize and solve problems using creative thinking skills, hands on problem solving skills and the ability to analyze and respond to data.* Skilled at effective verbal and written communications, including active listening skills and skill in presenting findings and recommendations.* Skilled at Multi-tasking, organizational skills and superb attention to detail.* Working knowledge of Hospice and other payer requirements.* Knowledge of clinic office procedures, medical practice and medical terminology. The above job description is a general overview of the responsibilities and competencies for this role at OneOncology. Specific details may vary based on the needs of the organization.