Oncology Pre-Authorization & Denial Specialist

Baptist Memorial Health Care; Memphis (TN); On-site; USD 55,000 - 75,000; Full time

Job summary

Baptist Memorial Health Care in Memphis is seeking an Authorization Denial Specialist to ensure chemotherapy and related services meet medical policies and guidelines. You will initiate pre-certifications and complete insurance verification for outpatient services.

You will review clinical information for denials, perform retro authorizations, and work with physicians to defend revenue while maintaining compliance with payers.

Qualifications

• 3 – 5 years of business experience in a healthcare environment, with 2 years in a clinical setting.
• Associates degree or 2 years of college.
• Critical thinking and judgement required.
• Ability to read and interpret medical policies, LCDs, and FDA guidelines.
• Strong organizational and documentation skills.
• Experience handling pre-certifications and prior authorizations is preferred.

Responsibilities

• Obtain and review treatment/therapy plan orders for medical necessity and appropriateness according to insurance medical policy/FDA/NCCN guidelines and requirements.
• Research insurance company medical policies, medical literature, and compendiums to determine eligibility for services. Utilize multiple healthcare websites
• Responsible for tracking, obtaining, and extending authorizations from various carriers in a timely manner
• Responsible for completing the Insurance Verification process
• Works closely with physicians and clinic staff obtain authorizations to promote positive patient outcomes, timely treatment and positive reimbursement
• Understands and complies with regulatory requirements by specific insurance companies and facilitates compliance by maintaining awareness of guidelines and ensuring compliance through communication and documentation to appropriate staff.
• Reviews, assesses and evaluates all authorization denial communications received in order to optimize reimbursement

Skills

Customer service

Communication

Critical thinking

Multi-tasking

Problem solving

Education

Associates degree or 2 years of college courses

Tools

Healthcare websites

Computer literacy

Job description

Baptist Memorial Health Care in Memphis is seeking an Authorization Denial Specialist to ensure chemotherapy and related services meet medical policies and guidelines. You will initiate pre-certifications and complete insurance verification for outpatient services.

You will review clinical information for denials, perform retro authorizations, and work with physicians to defend revenue while maintaining compliance with payers.