Prior Authorization Specialist
The Prior Authorization Specialist is responsible for obtaining and verifying prior authorizations from insurance payers for oncology treatments ordered by the physicians. Prior to a patient’s treatment, the Prior Authorization Specialist reviews patient insurance and clinical documents and contacts payers to receive prior authorization from the insurance payer. Authorization Specialists are responsible for verifying the treatment is authorized and verifying that required payer documentation and authorization records are on file.
ESSENTIAL DUTIES/RESPONSIBILITIES:
- Contact insurance payers to obtain prior authorization on timely basis, prior to a patient’s treatment. Includes gathering additional clinical information as necessary to obtain prior authorization.
- Work with doctors and nurses to understand patient treatment orders/plans, diagnosis, medical history in order to obtain prior authorization.
- Contact insurance payers to extend expired prior authorizations.
- Manage insurance changes and verify existing authorizations are valid.
- Understand insurance requirements for prior authorization.
- Understand payer processes to submit appropriate clinical documentation.
- Other duties as assigned.
SKILLS/REQUIREMENTS:
- 1-2 years in an oncology setting obtaining prior authorizations and experience working with insurance companies required.
*EXPERIENCE PREFERRED*
- Strong ability to navigate and research information on payer websites and payer documentation and speak with payer representatives over the phone.
- Experience working with insurance payers and obtaining prior authorizations.
- Strong computer skills, including Microsoft Office/Outlook /Word/Excel skills.
- Ability to learn new software quickly.
- Knowledge of Medical terminology and process
- Extremely Detail oriented.
- Ability to work on short deadlines.
- Ability to Multi-task
- Strong time management and organizational skills
Job Type: Full-time
Pay: $17.00 - $19.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Disability insurance
- Employee assistance program
- Flexible schedule
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Weekly day range:
Experience:
- Insurance verification: 2 years (Required)
- insurance prior authorization: 2 years (Required)
- Oncology: 1 year (Required)
Work Location: Remote