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 Senior Authorization Specialist role is responsible for supporting all

administrative aspects of treatments and procedures related to benefit verification and authorization. This role will ensure patient’s insurance requirements for reimbursement before treatments or procedures. Ensures pre-authorizations are obtained for Physician Orders for treatments 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 authorization team members, patients, physician, nurse and social worker. Work in specific areas of concern in the department on a project basis. Assist authorization team leadership 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.

Responsibilities:

· Supports the team responsible for obtaining pre-authorizations for Physician Orders for treatments

or procedures as required by the patient’s insurance carrier.

· Engages with authorization vendors on quality and production.

· Communicates with authorization team members, 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 and Practice Management System on authorization approvals and denials.

· Communicates with practice staff when the need for updated referrals arise.

· Communicates with practice 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 practices staff to notify of termed insurances.

· Communicates as necessary and in a timely fashion with the practice staff with regards to the status of pending authorizations.

· Keeps current on insurance carrier requirements for treatments and procedures.

· Follows policy and procedures outlined by management to ensure standardization of processes across the clinics.

· Works with the Account Receivable Team on denials and complete retro authorization requests and or medically necessary appeals.

· Review payer guidelines for medically necessity guidelines including frequency and prior testing requirements.

Required Qualifications:

EDUCATION & EXPERIENCE:

· High School diploma or equivalent.

· Two years experience in a directly related role preferred, but not required.

PHYSICAL REQUIREMENTS:

· High School diploma or equivalent required.

· 2+ year(s) of Prior Authorization experience.

· 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.

The above job description is a general overview of the responsibilities and competencies for this role at OneOncology. Specific details may vary based on the needs of the organization.