Pre-Authorization Specialist – Diagnostics & Reimbursement

OneOncology, LLC; Nashville (TN); On-site; USD 42,000 - 66,000; Full time

Job summary

OneOncology, LLC is seeking an Authorization Specialist to manage pre-authorizations for diagnostic testing or procedures and verify insurance requirements prior to services. You will liaise with physicians, nursing staff, and social workers to ensure financial feasibility for patients across clinics, and support training and process improvements.

Responsibilities include maintaining up-to-date EMR documentation, addressing insurer requirements, and coordinating with front office and imaging

Qualifications

• High School diploma or equivalent.
• Minimum 1 year of prior authorization experience; urology experience preferred.
• Medical insurance background required.

Responsibilities

• Obtains pre-authorizations for Physician Orders for diagnostic testing or procedure as required by the patient’s insurance carrier.
• Communicates with physician/clinical staff on reimbursement issues and/or pre-certification requirements by the patient’s insurance carriers.
• Ensures up-to-date documentation on patient’s accounts in Electronic Medical Record on authorization approvals and denials.
• Communicates with Insurance Authorization Coordinators the need for updated referrals.
• Communicates with front office manager and staff in the case of denials that will require rescheduling and/or peer-to-peer review by the ordering physician.
• Communicates with hospitals or other diagnostic facilities to correct any discrepancies.
• Contacts Insurance Authorization Coordinators to notify of termed insurances.
• Communicates as necessary and in a timely fashion with Front Office and imaging center staff with regards to the status of pending authorizations.
• Contacts Clinical Trial team to notify of denied scans for patients on study to verify coverage of scan by study.
• Keeps current on insurance carrier requirements for diagnostic testing and procedures.
• Follows policy and procedures outlined by management to ensure standardization of processes across the clinics.

Skills

Prior Authorization

Medical Insurance Knowledge

Customer Service

Communication

Multi-tasking

Attention to Detail

Education

High School diploma or equivalent

1+ year of Prior Authorization experience

Medical insurance background

Tools

MS Word

Excel

Outlook

EMR/Electronic Medical Record

Job description

OneOncology, LLC is seeking an Authorization Specialist to manage pre-authorizations for diagnostic testing or procedures and verify insurance requirements prior to services. You will liaise with physicians, nursing staff, and social workers to ensure financial feasibility for patients across clinics, and support training and process improvements.

Responsibilities include maintaining up-to-date EMR documentation, addressing insurer requirements, and coordinating with front office and imaging