Prior Authorization Specialist II – Oncology Care

Saint Francis Hospital, Inc.; Oklahoma City (OK); On-site; USD 42,000 - 52,000; Full time

Job summary

Saint Francis Hospital, Inc. Authorization Specialist II is responsible for ensuring the accuracy of insurance information and obtaining prior authorization for non-oncology, oncology, and radiation oncology infusions.

The role involves navigating detailed processes, NCCN guidelines, medical necessity reviews, and payer requirements to support timely approvals. The position requires a high school diploma or GED, 2 years of benefits verification or authorization experience (or 3 years

Qualifications

• Basic healthcare knowledge and insurance terminology including medical billing and insurance follow-up processes.
• PC and basic software skills.
• Proven keyboard skills with the ability to type 75 WPM.
• Excellent oral and verbal communication skills.
• Ability to navigate insurance websites to access patient eligibility and payment information.
• Ability to organize and prioritize work and the ability to be detail oriented.
• Ability to interact with physicians, physician offices and all levels of team members within the health system.

Responsibilities

• Monitors patient, referrals, and denials work queues to determine encounters that require pre-registration, verification, authorization, or corrections to ensure proper billing.
• Works encounters according to assignment and consistently meets daily and weekly productivity goals.
• Evaluates physician orders and pre-screens for medical necessity; notes frequency and duration of treatment plan and communicates directly with ordering provider or clinical staff to facilitate order revisions as indicated.
• Reviews clinical documentation for CPT and diagnosis code information to support authorization and precertification according to payer guidelines.
• Monitors, reviews, and processes authorizations and validates the requests are accurate, within the required timeline, and in compliance with the applicable insurance guidelines.
• Consults with pharmacy team members regarding provider ordered drugs in relation to payer preference to identify appropriate codes for authorization submission and to establish the appropriateness of the treatment regimen in alignment with NCCN and payer guidelines.
• Confers with pharmacy or clinical partners to facilitate additional information when required by payer.
• Coordinates with patient, referring physician's office, referring location, scheduled service area, financial counselors, case manager, and others, as appropriate to obtain additional information or provide information on patient financial status.
• Documents pertinent information and efforts in computer system based upon department documentation standards.
• Protects the privacy and security of patient health information to ensure that confidentiality is maintained.

Skills

Benefits verification

Authorization processes

Healthcare terminology

Typing 75 WPM

Excellent communication

Organization

Education

High School Diploma or GED

Job description

Saint Francis Hospital, Inc. Authorization Specialist II is responsible for ensuring the accuracy of insurance information and obtaining prior authorization for non-oncology, oncology, and radiation oncology infusions.

The role involves navigating detailed processes, NCCN guidelines, medical necessity reviews, and payer requirements to support timely approvals. The position requires a high school diploma or GED, 2 years of benefits verification or authorization experience (or 3 years