Oncology Prior Authorization Specialist - Onsite

US Oncology Network-wide Career Opportunities; Eugene (OR); Sur place; USD 36 000 - 40 000; Plein temps

Résumé du poste

The US Oncology Network in Eugene, Oregon, is seeking a Prior Authorization Specialist/Insurance Reviewer - Clinical to secure insurance authorizations for patient treatments, testing, and procedures. This fast-paced role requires close collaboration with care teams and payers to minimize delays and ensure timely access to care.

Responsibilities include reviewing medical necessity, communicating with physicians and staff, updating payer guidelines, and obtaining pre-certifications for oncology

Qualifications

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

Responsabilités

• Reviews, processes and audits the medical necessity for treatments including radiation oncology, gynecologic surgery, genetic lab testing, imaging, and chemotherapy treatment for each patient.
• 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.

Connaissances

Prior authorization

Formation

High school degree or equivalent

Description du poste

The US Oncology Network in Eugene, Oregon, is seeking a Prior Authorization Specialist/Insurance Reviewer - Clinical to secure insurance authorizations for patient treatments, testing, and procedures. This fast-paced role requires close collaboration with care teams and payers to minimize delays and ensure timely access to care.

Responsibilities include reviewing medical necessity, communicating with physicians and staff, updating payer guidelines, and obtaining pre-certifications for oncology