Drug Authorization Specialist

Astera Cancer Care; Northern (KY); Hybrid; USD 40,000 - 60,000; Full time

Job summary

OneOncology is seeking a role that coordinates pre-authorizations and manages the flow between clinical staff, physicians, and patient accounting to ensure insurance requirements are met before treatment.

You will educate patients on coverage, deductible, copay, and out-of-pocket costs, and assist with financial counseling for uninsured or underinsured patients.

Qualifications

• High School diploma or equivalent required.
• Medical insurance background preferred.
• Must be willing and able to lift up to 25 pounds.
• Must be willing to travel to satellite clinics.

Responsibilities

• Obtains pre-authorizations for Physician Orders 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.
• Communicates with physician/clinical staff concerning off label drug use.
• Coordinates information required or requested by Patient Accounting within the mandated timeframe.
• Maintains up-to-date documentation on patient's accounts in EMR and Patient Management systems.
• Keeps current on drug and insurance carrier requirements and participates in policy adherence.

Skills

Communication skills

Customer service

Organizational skills

MS Word/Excel/Outlook

Education

High School diploma or equivalent

Tools

MS Word

Excel

Outlook

Medical office software

Job description

OneOncology 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 marketplace 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

This role functions as a liaison between clinical staff, physicians and patient accounting making sure that patient's insurance requirements for reimbursement before treatment occurs while maintaining knowledge on drugs used to treat patients. Communicate as needed with patients on coverage that may affect their financial liability.

Responsibilities

• Obtains pre-authorizations for Physician Orders 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.
• Communicates with physician/clinical staff concerning off label drug use.
• Coordinates and communicates information required or requested by Patient Accounting within the mandated timeframe.
• Ensures up-to-date documentation on patient's accounts in Electronic Medical Record and Patient Management on follow up or ongoing drug authorizations.
• Keeps current on drug and insurance carrier requirements.
• Utilizing all sources available to stay abreast of drug information (indications, Pharma programs, pre-certification requirements etc.)
• Follows policy and procedures outlined by management to ensure standardization of processes across the clinics.
• Responsible for patient assistance coordination with the Patient Advocate and communicates with clinical staff to coordinate treatment plan requirements for indigent drug.
• Educate patients about their insurance coverage and benefits, including deductible, copay, coinsurance and estimated out of pocket costs as needed.
• Determine patient financial ability to pay and provide financial counseling services regarding payment arrangements and financial assistance for uninsured and underinsured patients by phone or in person as needed.
• Maintains continued authorizations of drugs ensuring that all treatment dates are covered for reimbursement.
• Resolve items in task management related to drug authorization issues.

Additional responsibilities may be assigned to help drive our mission of improving the lives of everyone living with cancer.

Required Qualifications

• High School diploma or equivalent required.
• Medical insurance background
• Must be willing and able to lift up to 25 pounds.
• Must be willing and able to travel to satellite clinics when necessary.

Essential Competencies

• Attendance is an essential job function.
• Excellent written and verbal communication skills with the ability to effectively communicate and establish collaborative relationships with physicians, patients, clinical and administrative staff, and the public.
• Excellent customer service skills.
• Knowledge of clinic office procedures, medical practice and medical terminology.
• Ability to recognize, evaluate and solve problems.
• Strong organizational skills and attention to detail.
• Proficient in the use of end-user computer applications regarding productivity (MS Word, Excel, Outlook), database and patient scheduling and other medical information systems.
• Ability to operate various types of office equipment.

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.

OneOncology was founded by community physicians, for community physicians, with the mission of improving the lives of everyone living with cancer and other diseases. Our goal is to enable community medical practices to remain independent and to improve patient access to care in their communities, all at a lower cost than in the hospital setting.

OneOncology supports our platform of community medical practices through group purchasing, operational optimization, practice growth, and clinical innovation. Our partner practices comprise approximately 2,300+ providers who care for approximately 1.5 million patients across 20 states.