Precertification Analyst

GOEBEL FIXTURE COMPANY; Rogers (AR); On-site; USD 42,000 - 54,000; Full time

Job summary

Highlands Oncology seeks a Precertification Analyst to obtain prior authorizations for imaging and oncology services. You will fill forms, submit records, and liaise with patients, insurers, and clinical staff to ensure timely approvals.

Daily duties include reviewing schedules, coordinating with nursing, and maintaining authorization data in OncoEMR and G4 systems while upholding patient confidentiality.

Qualifications

• Knowledge of g4/PM System & OncoEMR.
• Clear and concise communication.
• Ability to work independently and as part of a team.
• Attention to detail.
• Strong knowledge of medical terminology.
• Professionalism in appearance/dress code.
• Knowledge of ICD-10-CM, HCPCS, and CPT codes.

Responsibilities

• Obtain prior authorizations for imaging/services as applicable.
• Fill out forms online or on paper; retrieve and submit records.
• Coordinate with patients, insurance companies, and clinical staff.
• Review imaging schedules to determine insurances needing prior authorization.
• Communicate with nursing and medical staff about restrictions or requirements.
• Maintain authorization information in OncoEMR and G4.
• Work with insurance verification to ensure coverage is up to date.
• Handle chemotherapy/infusion-related authorizations as designated.
• Assist with outside treatments and genetic testing authorizations as needed.
• Ensure timely submission of authorizations for procedures.

Skills

g4/PM System

OncoEMR

Medical terminology

Communication

Teamwork

Attention to detail

ICD-10-CM knowledge

HCPCS/CPT codes

Education

High School Diploma or equivalent

1-2 years medical office experience, preferred

Tools

OncoEMR

Job description

• Location 2809 W Ajax Ave,Ste 100,Rogers, AR, 72758,United States
• Job Category Prior Authorization, Insurance Verification, Adminsitrative
• Employee Type NonExempt - Full Time
• Manage Others No

• Name Eric Pathana
• Email [e-mail]

Make a meaningful impact in the lives of cancer patients every day.

As a Precertification Analyst, you play a critical role in helping patients access the treatments and services they need by navigating insurance requirements with accuracy, urgency, and compassion. Join our dedicated oncology team and become an essential advocate for patients during some of their most challenging moments.

Highlands Oncology began in 1996 with three physicians and a desire to change the face of oncology care in our community. Dr. Malcolm Hayward, Dr. Dan Bradford, and Dr. Thad Beck knew that patients do better at home, in the community where they live and work, and where their support system is already in place. In furthering that goal, Highlands has grown with the region from a single location 26 years ago, to 6 locations in Northwest and Northcentral Arkansas today employing more than 800 diverse team members.

As Northwest Arkansas continues to grow, so must the services and providers available in the region. Highlands Oncology is committed to remaining on the cutting edge to ensure our community has access to the very best cancer care. What we have is something quite unique right here in our own backyard with a caring multidisciplinary team focused on treating patients like family.

Job Summary:

The Precertification Analyst for imaging services obtains prior authorizations for services as applicable. Fills out forms online or on paper; retrieves and submits records as needed to obtain authorizations. Works with patients, insurance companies, and clinical staff members.

Job Duties / Responsibilities:

• Review of imaging schedules for Benton County Clinic, North Hills Clinic, and Parkway Clinic daily to determine the insurances that require prior authorization for imaging.
• Answers and resolves incoming calls regarding STAT requests.
• Prompt obtainment of authorization(s) for any urgent add-on requests.
• Maintain accurate and current authorization(s) information in OncoEMR and G4.
• Work closely with imaging personnel to determine what date requires review to guarantee all authorizations are obtained in a timely manner.
• Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with insurance plans.
• Work closely with the insurance verification team to ensure insurance coverage is up to date.
• Maintain a professional relationship with physician/nurses addressing questions, concerns regarding imaging orders/diagnoses.
• Maintain a good working relationship with outside referring providers and staff.
• Maintain patient/clinic confidentiality.
• Ability to cover positions for Outside Treatments/Genetic Testing/In-patient Authorizations, as designated.
• Maintain pleasant/helpful attitude towards patients and staff.
• Perform all related duties as required by the Precertification Supervisor, Revenue Cycle Manager, and Business Office Director.

Depending upon designation, your duties may vary as described below:

• Responsible for daily chemotherapy infusions/injections schedule.
• Will obtainpriorauthorizationsforanytreatments/drugsthatrequireauthorization.
• Willcommunicatewithphysician teams promptly should any issues arise with obtaining prior authorization.
• Dailyreviewofchemotherapy/infusionschedulesandauthorizeanydrugs/treatmentsthatrequire authorization.
• WorkcloselywithPatientAssistanceRepresentativetoobtaindrugreplacement(s),as needed.
• Maintainaccurateandcurrentauthorization(s)informationforchemotherapy/infusionsinOncoEMRand g4.
• Willobtainpriorauthorizationsforanytreatments/drugsthatrequireauthorization.
• Will communicatewithoutsidephysicianteamspromptlyshouldanyissuesarisewithobtainingprior authorization.
• Communicatecloselywithpharmacytoobtainuptodatedrugcosts/changestoprovideaccurateprice quotes.
• Calculate cost analysis for ordered treatment and patient responsibility for each treatment after deductible/outofpocket.Oncedrugpricingdone,forward toFCattreatinglocationforthemtoadjust cost if pt receiving ANY financial assistance (pt assistance vs free drug program).
• Forwardcalculatedamountowedbyapatientforoutsideinfusions/treatmentstodesignatedFinancial Counselor at all Highlands facilities.
• Fills out forms online or on paper; retrieves and submits records as needed to obtain/maintain authorizations.
• Workswithpatients,insurancecompanies,andclinicalstaff members.
• Reviewoftherapyandoutsideorderschedules atallHighlandsfacilitiesdailytodeterminetheinsurances that require prior authorization for upcoming procedures/surgeries.
• Communicatewithnursingandmedicalstafftoinformthemofanyrestrictionsorspecialrequirements in accordance with insurance policies and guidelines.
• WorkonandmaintaintheoutsideorderspreadsheetthatisusedforTheBreastCenter orders.
• Fillsoutforms online or on paper; retrieves and submits records as needed to obtain/maintain authorizations.
• Works with patients,insurancecompanies,andclinicalstaff members.
• ReviewofVApatientsdailytodeterminecoveragerequiringpriorauthorizationforupcomingservices being provided to patients.
• WorkcloselywithVApersonneltodeterminewhatdaterequiresreviewto guaranteeallauthorizations are obtained in a timely manner.
• Communicatewithnursingandmedicalstafftoinformthemofanyrestrictionsorspecialrequirements in accordance with specific VA coverage.
• WorkincomingVAreferrals,expiringauthorizations,outsideVAorders,andconsultrequestsassentby the VA.

Pre-Certification Analyst – SURGICAL ONCOLOGY

• Obtains prior authorizations for services as applicable.
• Filloutformsonlineoronpaper;retrievesandsubmitsrecordsasneededtoobtainauthorizations.
• Works with patients, insurance companies, and clinical staff members.
• Review of surgery schedules for HighlandsOncology surgeonsdaily to determine theinsurancesthat require prior authorization for upcoming procedures/surgeries.
• Workcloselywiththe surgicaldepartmentandhospitalpersonneltodeterminewhatdaterequires review to guarantee all authorizations are obtained in a timely manner.
• Communicateswith nursing and medical staff to inform them of any restrictionsor special requirements in accordance with specific insurance plans.
• Workwithsurgicalstaffdailytoensurethatrequestsaresubmittedtimelytoallowforinsurance review.
• Filloutformsonlineoronpaper;retrievesandsubmitsrecordsasneededto obtain authorizations.
• Works with patients, insurance companies, and clinical staff members.
• ReviewofimagingschedulesatallHighlandsfacilitiesdailytodeterminetheinsurancesthatrequire prior authorization for imaging.
• Workcloselywithimagingpersonneltodeterminewhatdaterequiresreviewtoguaranteeall authorizations are obtained in a timely manner.

Required Skills/Abilities:

• Knowledge of g4/PM System & OncoEMR
• Communicates clearly and concisely.
• Ability to work independently and as part of a team.
• Ability to maintain good working relationships.
• Demonstrates attention to detail.
• Strong knowledge of medical terminology.
• Demonstrates professionalism in appearance/dress code.
• Knowledge of ICD-10-CM, HCPCS, and CPT codes.

Certifications/Licenses/Education/or Experience in a related field:

• High School Diploma or equivalent
• Minimum of 1-2 years of medical office experience, preferred.

Physical Requirements:

• Sitting for prolonged periods of time at a desk.
• Computer use that requires visual acuity, typing, use of mouse/keyboard, and staring at a screen for extended periods of time.
• Occasionally lifting objects of up to 25 pounds such as files, office supplies, assisting patients when needed, etc.
• Walking and standing for continuous periods around the office or clinic as needed.
• Fine motor skills for tasks like typing, writing, handling small objects or equipment and materials.
• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. Reasonable accommodation may be provided to enable individuals with disabilities to perform essential functions.
• Due to the nature of our business and the use of radiation and hazardous chemicals, it is imperative that all employees foster a culture and environment of safety.
• Safety Sensitive: In accordance with the Arkansas code this position is designated as a safety sensitive position wherein the employee performing the job duties under the influence may constitute a threat to health or safety.

Summary

Highlands Oncology offers a full suite of benefits that includes those pictured below and MANY MORE...