Chemotherapy Authorization Specialist | Patient Advocate

US Oncology Inc.; Fairfax (VA); Presencial; USD 42 000 - 64 000; Tempo integral

Resumo da oferta

Virginia Cancer Specialists is seeking a Full Time Chemo Authorization Specialist for our Administrative Office in Fairfax, Virginia. You will verify insurance eligibility, obtain prior authorizations, and research denials to ensure timely payments, serving as a liaison between patients and payers and supporting compliance with the US Oncology Network.

Under supervision, you will update payer guidelines, assist with duties of Patient Financial Counselors, and coordinate with nursing and medical

Qualificações

• High school diploma 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.

Responsabilidades

• 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.
• Maintains a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization.
• Updates coding/payer guidelines for clinical staff. Tracks pathways and performs various other business office functions on an as needed basis.

Conhecimentos

Insurance verification

Authorization processing

Payer communication

Office procedures

Formação académica

High school diploma or equivalent

Associate degree in Healthcare or LPN license or Certified Pharmacy Tech

Descrição da oferta de emprego

Virginia Cancer Specialists is seeking a Full Time Chemo Authorization Specialist for our Administrative Office in Fairfax, Virginia. You will verify insurance eligibility, obtain prior authorizations, and research denials to ensure timely payments, serving as a liaison between patients and payers and supporting compliance with the US Oncology Network.

Under supervision, you will update payer guidelines, assist with duties of Patient Financial Counselors, and coordinate with nursing and medical