Sr. Authorization Specialist
OneOncology
OneOncology is positioning community oncologists to drive the future of cancer care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer. Our team is bringing together leaders to the market place to help drive OneOncology’s mission and vision.
Why join us? This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of community oncologists and the patients they serve.
Job Description:
The Sr. Authorization Specialist is responsible for all administrative aspects of outpatient diagnostic testing and procedure benefit verification and authorization. This role will ensure patient’s insurance requirements for reimbursement before diagnostic testing or procedure. Obtains pre-authorizations for Physician Orders for diagnostic testing or procedure as required by the patient’s insurance carrier. Ensure the financial feasibility of treating each patient in our clinics by communicating and working closely with patients, physician, nurse and social worker. Work in specific areas of concern in the department on a project basis. Assist Patient Finance Manager in training staff, projects and implementations. Maintain in-depth knowledge of authorization process as well as reimbursement methodologies. Maintain knowledge of collection techniques and collection laws. This role also will be responsible for orienting, training, and mentoring new employees during the on boarding process. The Sr. Authorization Specialist will be knowledgeable in their respective team roles and serve as the main point of contact for new employees. The Sr. Authorization Specialist will be a liaison between Patient Accounting staff, management, and director to ensure effective communication.
ESSENTIAL FUNCTIONS:
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.
Additional responsibilities may be assigned to help drive our mission of improving the lives of everyone living with cancer.
Lab Information System, Pharmacy Information System, Entire Chart/Electronic Medical Record (EMR), Electronic Billing System (EBS).
Works denial worklist completing retro authorization request and or medically necessary appeals.
Review payer guidelines for medically necessity guidelines including frequency and prior testing requirements.
Willingness and desire to assist in the orientation of new hires.
Oversee the orientation of new hires during determined orientation period.
Monitors the orientation checklist so that outcomes are met within the appropriate time frame.
Communicate with members of management regarding new hire progress.
Collaborate with manager and trainer at 15, 45, and 90 day evaluations.
Provides expertise in skills and knowledge.
Follows and understands all policies and procedures ensuring best practice.
Collaborate with the training team on assessed education needs to develop an organized, proficient, and quality focused education program.
Works in collaboration with all departments to ensure organizational goals are met.
Attend training sessions to develop skill set for adult learning training strategies.
Completes assigned work as Authorization Specialist in addition to assigned Sr. Authorization Specialist training responsibilities.
Fulfills daily responsibilities as Authorization Specialist when individual Sr. Authorization Specialist assignment is not required.
Supports and adheres to the company mission, vision, and values.
Exhibits professionalism and common courtesy.
EDUCATION & EXPERIENCE:
High School diploma or equivalent.
1+ year(s) of Prior Authorization experience required, preferably in an oncology healthcare setting.
Medical insurance background required.
Essential Competencies:
Attendance is an essential job function.
Ability to work effectively with all levels of management and other colleagues
Ability to demonstrate initiative and mature judgment.
Ability to demonstrate high degree of professionalism and adaptability.
Ability to demonstrate proficiency in the use of end-user computer applications (MS work, Excel, Outlook), database and patient scheduling and other medical information systems.
Ability to demonstrate strong customer service delivery skills.
Ability to utilize websites, portal and electronic options when available to increase efficiency
Ability to follow oral and written instructions.
Ability to recognize and solve problems using creative thinking skills, hands on problem solving skills and the ability to analyze and respond to data.
Skilled at effective verbal and written communications, including active listening skills and skill in presenting findings and recommendations.
Skilled at Multi-tasking, organizational skills and superb attention to detail.
Working knowledge of Hospice and other payer requirements.
Knowledge of clinic office procedures, medical practice and medical terminology.
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