Pharmacy Clerk

US Oncology Inc.; Antioch (CA); On-site; USD 35,473 - 43,587; Full time

Job summary

A healthcare organization in Antioch, California, seeks a Medical Authorization Specialist to ensure proper reviews and approvals for chemotherapy treatments. Responsibilities include obtaining insurance authorizations, communicating with staff and patients, and addressing reimbursement concerns. Qualified candidates should have at least three years of experience in medical insurance verification. This position offers an hourly rate ranging from $25.75 to $31.64 depending on skills and experience, in a controlled medical practice environment.

Qualifications

• Minimum three (3) years medical insurance verification and authorization required.

Responsibilities

• Reviews, processes and audits medical necessity for patient chemotherapy treatment.
• Communicates with nursing and medical staff about insurance requirements.
• Provides feedback on documentation issues and payer issues.
• Communicates with patients and pharmacies for prior authorizations.
• Tracks pathways and performs business office functions.
• Obtains insurance authorization for chemotherapy services.
• Researches alternative resources for non-covered services.
• Maintains knowledge of authorization requirements and regulations.
• Adheres to confidentiality and legal guidelines.

Education

High School degree or equivalent

Job description

Overview

HOURLY RATE (DEPENDING ON SKILLS/EXPERIENCE): $25.75 - $31.64

SCOPE: Under general supervision, reviews chemotherapy regimens in accordance to reimbursement guidelines. Obtains necessary pre‑certifications and exceptions to ensure no delay in reimbursement of treatments. Researches denied services and alternative resources to pay for treatment. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards.

Responsibilities

• Reviews, processes and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence
• Communicates with nursing 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.
• Communicates with Patients, Insurances and Pharmacies for any prior authorization needs.
• Tracks pathways and performs various other business office functions on an as needed basis
• Obtains insurance authorization and pre‑certification specifically for chemotherapy services. Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
• Researches additional or alternative resources for non‑covered chemotherapy services to prevent payment denials.
• 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.

Qualifications

• High School degree or equivalent required

Experience Requirements

• Minimum three (3) years medical insurance verification and authorization required

Work Environment

The work of this position is performed in an environmentally controlled medical practice environment. The position requires the ability to work under pressure and with a diverse population, including staff, physicians, clients, patients, insurance companies and other members of the public on a regular basis. The position may cause frequent exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations and other conditions common to a clinical environment.