Job Description
Responsible for obtaining authorization for Radiation Oncology procedures, imaging, to include submission and tracking of authorization requests for resolution. Duties require ongoing coordination and communication with the clinical teams given the complexity and intricacies of payor coverage policies and approval pathways, and time- sensitive treatment plans.
This position will work remotely.
- Maintains knowledge of Radiation Oncology insurance carriers’ billing requirements to promote timely claims processing and reimbursement.
- Initiates, performs follow-up, and secures prior authorization, pre-determination, or medical reviews.
- Communicates effectively with payers and various stakeholders (clinical teams, pharmacy, financial counselors and other departments) regarding the status of authorizations, coverage and/or other updates, as needed.
- Documents case activity, communications, and correspondence in Epic to ensure completeness and accuracy of account activity, and that actions are taken to resolve outstanding authorization issues.
- Obtains reauthorizations; initiates requests, gathers additional required information, tracks progress.
- Expedites responses from insurance carriers and other payers and maintains contact (directly or through financial counselors) with patients to keep them continuously informed of coverage and authorization issues.
- Responds to urgent requests for add-ons or changes in treatment plans in a timely manner to ensure prior authorization is obtained.
- Assists with patient inbound and outbound calls, as needed.
- Within scope of job, requires critical thinking skills, decisive judgement and the ability to work independently.
- Complies with all relevant hospital procedures, regulations and protocols and maintains confidentiality at all times.
- Identifies and analyzes denied claims and works to overturn denials while utilizing Epic work queues and other resources.
Job Requirements
Applicable Experience:
2 years
Diploma
Job Details
Full Time
Day (United States of America)
