Authorization Specialist

• Ensure accuracy of insurance information and obtain prior authorization and predetermination requirements for non-oncology infusions, oncology infusions, and radiation oncology
• Monitor patient, referral, and denial work queues to identify encounters requiring pre-registration, verification, authorization, or corrections
• Process encounters according to assignment and meet daily and weekly productivity goals
• Evaluate physician orders and pre-screen for medical necessity
• Review treatment plan frequency and duration and communicate with ordering providers or clinical staff regarding order revisions
• Review clinical documentation for CPT and diagnosis codes supporting authorization and precertification according to payer guidelines
• Monitor, review, and process authorizations for accuracy, timeliness, and insurance-guideline compliance
• Consult with pharmacy team members regarding provider-ordered drugs, payer preferences, authorization codes, and treatment-regimen appropriateness under NCCN and payer guidelines
• Coordinate with patients, referring physician offices, referring locations, scheduled service areas, financial counselors, case managers, and others to obtain or provide information
• Document pertinent information and efforts in the computer system according to department standards
• Protect the privacy and security of patient health information
• Work directly with patients, customers, healthcare professionals, and staff by telephone or face-to-face interaction

Authorization Specialist – II

• Monitor patient, referral, and denial work queues to identify encounters requiring pre-registration, verification, authorization, or corrections
• Work encounters according to assignment while meeting daily and weekly productivity goals
• Evaluate physician referral and authorization requirements and ensure requirements are met before procedures
• Review clinical documentation for CPT and diagnosis code information supporting authorization/precertification
• Monitor, review, and process authorizations in accordance with timelines and insurance guidelines
• Coordinate with departments and ancillary areas for special needs or resources
• Counsel clinical partners and patients to obtain additional payer-required information
• Coordinate with patients, referring physician offices, referring locations, scheduled service areas, financial counselors, case managers, and others
• Document pertinent information and efforts in the computer system
• Protect the privacy and security of patient health information
• Work independently and make minor decisions in a complex technical or professional field
• Work with patients, customers, healthcare professionals, and staff by telephone or face-to-face