Oncology Prior Authorization Specialist - Fast-Paced

US Oncology Inc.; Eugene (OR); On-site; USD 36,000 - 40,000; Full time

Benefits offered by this job

Medical/Dental/Vision

Life Insurance

401(k)

Job summary

US Oncology Inc. in Eugene, Oregon is seeking a Prior Authorization Specialist/Insurance Reviewer - Clinical to secure insurance authorizations for treatments, testing, and procedures, coordinating with care teams to prevent delays.

This on-site role thrives in a fast-paced, high-volume setting. Responsibilities include reviewing medical necessity, communicating with nursing and physicians, updating payer guidelines, obtaining pre-certifications, and ensuring compliance with HIPAA and

Qualifications

• High school degree or equivalent.
• Minimum three (3) years of prior authorization experience required. Revenue cycle experience preferred.

Responsibilities

• Reviews, processes and audits the medical necessity for treatments including radiation oncology, gynecologic surgery, genetic lab testing, imaging, and chemotherapy treatment for each patient. Documentation of regimen related to pathway adherence and payer guidelines.
• Communicate with nursing, physician, pharmacists 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.
• Updates coding/payer guidelines for clinical staff. Tracks pathways and performs various other business office functions on an as needed basis.
• Obtains insurance authorization and pre-certification for various oncology & hematology related services.
• 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 HIPAA laws and guidelines with regards to patient’s records.
• Other duties as requested or assigned.

Skills

Prior Authorization

Education

High school degree

Job description

US Oncology Inc. in Eugene, Oregon is seeking a Prior Authorization Specialist/Insurance Reviewer - Clinical to secure insurance authorizations for treatments, testing, and procedures, coordinating with care teams to prevent delays.

This on-site role thrives in a fast-paced, high-volume setting. Responsibilities include reviewing medical necessity, communicating with nursing and physicians, updating payer guidelines, obtaining pre-certifications, and ensuring compliance with HIPAA and