Oncology Pharmacy Authorization Specialist

US Oncology Inc.; Antioch (CA); On-site; USD 35,000 - 44,000; Full time

Job summary

US Oncology Inc. in California is seeking an Insurance Verification Specialist to review chemotherapy regimens for medical necessity and obtain pre-certifications to avoid delays in treatment reimbursement.

You will coordinate with nursing staff and physicians, communicate with patients, insurers, and pharmacies for prior authorizations, research denials, and support compliance with the US Oncology Compliance Program, the Code of Ethics, and HIPAA.

Qualifications

• High School degree or equivalent required.
• Minimum 3 years medical insurance verification and authorization experience.

Responsibilities

• Reviews, processes and audits medical necessity for chemotherapy treatment and records pathway adherence.
• Communicates with nursing and medical staff about restrictions or special requirements per insurance plans.
• Provides feedback to physicians and management about documentation and payer issues.
• Interacts with patients, insurers and pharmacies for prior authorization needs.
• Tracks pathways and performs related business office functions as needed.
• Obtains insurance authorization and pre-certification for chemotherapy services; acts as patient advocate.
• Researches resources for non-covered chemotherapy services to prevent denials.
• Maintains knowledge of chemotherapy authorization requirements for payers and regulations.
• Adheres to confidentiality, HIPAA laws and guidelines with regards to patient records.
• Other duties as assigned.

Education

High School degree or equivalent

Job description

US Oncology Inc. in California is seeking an Insurance Verification Specialist to review chemotherapy regimens for medical necessity and obtain pre-certifications to avoid delays in treatment reimbursement.

You will coordinate with nursing staff and physicians, communicate with patients, insurers, and pharmacies for prior authorizations, research denials, and support compliance with the US Oncology Compliance Program, the Code of Ethics, and HIPAA.