Chemo Authorization Specialists

US Oncology Network-wide Career Opportunities; Fairfax (VA); On-site; USD 42,000 - 65,000; Full time

Job summary

Virginia Cancer Specialists in Fairfax, VA, is hiring a Full Time Chemo Authorization Specialist to verify insurance eligibility, obtain authorizations, and support timely payments.

You will liaise with patients and payers, research denials, and assist with documentation, coding updates, and compliance in a busy cancer care environment. This role requires attention to detail and knowledge of payer guidelines to ensure smooth financial pathways for chemotherapy services.

Qualifications

• High school diploma or equivalent required; associates degree preferred.
• Two years medical insurance verification and prior authorization experience preferred.
• Billing and coding experience preferred.

Responsibilities

• Review, process and audit medical necessity for chemotherapy treatment documentation.
• Act as liaison between patients and payers to resolve reimbursement questions and obtain authorizations.
• Research denied services and identify resources for non-covered services to prevent denials.
• Provide support to physicians and staff with pathway documentation and payer issues.
• Update coding/payer guidelines for clinical staff and track reimbursement pathways.

Skills

Medical insurance verification

Pre-authorization

Billing and coding

Education

High school diploma or equivalent

Associate’s degree in Healthcare

LPN Virginia State License

Certified Pharmacy Technician

Job description

Overview

Are you looking for a career and not just a job in the Medical field? Virginia Cancer Specialists, an affiliate of McKesson Specialty Health and US Oncology, a leader in Cancer care, is seeking a Full Time Chemo Authorization Specialist for our Administrative Office in Fairfax, Virginia.

Under general supervision verifies insurance eligibility, benefits, verification, prior authorization and researches denied services to ensure payments are processed on a timely basis. Acts as a liaison to ensure accurate processing of all claims. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards.

Responsibilities

• ESSENTIAL DUTIES AND 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 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.
• Updates coding/payer guidelines for clinical staff. Tracks pathways and performs various other business office functions on an as needed basis.

Qualifications

• MINIMUM QUALIFICATIONS:
• High school degree or equivalent. Associates degree in Healthcare, LPN Virginia State License or Certified Pharmacy Tech preferred. Minimum two (2) years medical insurance verification and authorization preferred. 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.

Join us at Virginia Cancer Specialists, where meeting and exceeding the needs of our patients is our primary goal!

The US Oncology Network is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.