Seeking Experienced Drug Authorization Rep/Treatment Analyst for Complex Specialty Practice in Atlanta!
***Opportunity for a hybrid schedule after demonstrated proficiency and performance!***
Seeking a forward-thinking, self-motivated Prior Authorization/Treatment Analyst with oncology or related experience who can continue to propel our organization in the right direction and celebrate successes! Come join our team in the fight against cancer!
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Obtains insurance authorization and pre-certification and/or authorizations, specifically for chemotherapy services.
- Obtaining prior authorizations for drugs, surgeries and services requiring insurance carrier prior authorization and communicate with insurance payers for prior authorization approval.
- Appeal insurance companies after prior authorization refusals, assess accounts for completeness and accuracy.
- Reviews, processes, and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence.
- Maintains a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization.
- Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
- Research additional or alternative resources for both covered and non-covered chemotherapy services to prevent payment denials.
- Provides a contact list for patient's community resources including special programs, drugs and pharmaceutical supplies and financial resources.
- Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patient's records.
Minimum of three (3) years medical insurance verification and authorization required. Experience with billing for Medicare, Medicaid and other third parties required. A minimum of 2-3 years' experience in physician coding and billing is required. Prior experience with Centricity or other electronic medical records (EMR) highly preferred!
If you are committed to patient service and like being hands-on in several aspects of medical billing and would like to further develop your experience and skill set, it is encouraged to apply!
Job Type: Full-time
Weekly day range:
Ability to Relocate:
- Atlanta, GA 30318: Relocate before starting work (Required)
Work Location: In person