Oncology - Prior Authorization Specialist; rs

Position: Oncology - Prior Authorization Specialist (Immediate Joiners)
Location: Bengaluru

Responsibilities
Manage Prior Authorization Process:
Oversee the entire prior authorization process for oncology treatments, procedures, and medications, ensuring timely and efficient approvals
Review Requests:
Evaluate prior authorization requests to confirm they meet medical necessity criteria and payer guidelines
Collaborate with Care Teams:
Work closely with oncologists, nursing staff, and billing teams to gather necessary clinical documentation and ensure it is submitted accurately and promptly
Insurance Coordination:
Coordinate with insurance companies to resolve coverage issues, denials, and appeals, ensuring that patients receive the care they need without unnecessary delays
Record Keeping:
Maintain accurate records of all prior authorization requests, including approvals, denials, and appeals, ensuring documentation is compliant and well-organized
Proactive Problem Resolution:
Identify and address barriers to timely approvals, proactively addressing payer-specific requirements and facilitating smoother workflows
Policy & Guideline Updates:
Stay informed on insurance policy changes, payer guidelines, and new oncology treatments to ensure compliance and accurate processing of requests
Provide Feedback & Insights:
Support oncology care teams by offering feedback to improve the prior authorization workflow and streamline operational efficiency
Utilize Technology:
Use electronic medical records (EMR) systems (e.g., OncoEMR) and prior authorization platforms to manage and streamline processes
Compliance:
Ensure all communications and documentation comply with HIPAA and other relevant regulatory standards

Qualifications

Experience:

Minimum of 1 years of experience managing medical prior authorizations, specifically within oncology

Preferred Experience:

Experience working in a cancer center or with oncology clients is highly preferred
Knowledge:
In-depth understanding of oncology treatments, procedures, and insurance requirements for medical prior authorizations
Insurance & Reimbursement:
Strong understanding of insurance policies, reimbursement processes, and medical necessity criteria for oncology care
Technical Proficiency:
Proficient in EMR systems (e.g., OncoEMR or similar platforms) and multiple payer portals, plans, and prior authorization tools
Communication

Skills:

Excellent communication and interpersonal skills, with the ability to effectively liaise between healthcare teams, patients, and insurance payers
Detail-Oriented:
Ability to maintain accurate and organized documentation in a fast-paced environment
Collaboration & Independence:
Ability to work independently and collaboratively with care teams in a dynamic oncology care setting
Compliance Knowledge:
Strong knowledge of HIPAA compliance and other regulatory standards
Preferred

Certifications:

Certification in Medical Coding, Healthcare Administration, or a related field is a plus