Chemotherapy Authorization & Reimbursement Specialist

US Oncology Network-wide Career Opportunities; Antioch (CA); On-site; USD 34,000 - 44,000; Full time

Job summary

US Oncology Network-wide Career Opportunities seeks a detail-oriented insurance verification specialist to review chemotherapy regimens for medical necessity and secure pre-certifications to avoid delays in treatment. You will collaborate with nursing, physicians, and payer representatives to resolve authorization issues and ensure compliant reimbursement.

The role requires a minimum of three years in medical insurance verification, a high school diploma, and strong communication skills to

Qualifications

• High School degree or equivalent required.

Responsibilities

• Reviews, processes and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence.
• 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.
• Communicates with Patients, Insurances and Pharmacies for any prior authorization needs.
• Tracks pathways and performs various other business office functions on an as needed basis
• Obtains insurance authorization and pre-certification specifically for chemotherapy services. Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
• Researches additional or alternative resources for non-covered chemotherapy services to prevent payment denials.
• Maintains a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization.
• Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patient*s records
• Other duties as requested or assigned.

Education

High School degree or equivalent

Job description

US Oncology Network-wide Career Opportunities seeks a detail-oriented insurance verification specialist to review chemotherapy regimens for medical necessity and secure pre-certifications to avoid delays in treatment. You will collaborate with nursing, physicians, and payer representatives to resolve authorization issues and ensure compliant reimbursement.

The role requires a minimum of three years in medical insurance verification, a high school diploma, and strong communication skills to