Insurance Authorization Coordinator - Oncology

Newport News, Virginia

This position is remote work eligible for candidates residing in the following states: FL, GA, , KS, KY, MS, NC, OK, PA*, SC, SD, TN, VA.
* Some county exclusions may apply.

The Insurance Authorization Coordinator works under the supervision of the Practice Manager and is responsible for researching, follow up and resolving open and pending authorizations in a timely manner. The Coordinator obtains, validates and updates insurance information; provides patient financial obligations; reviews insurance benefits; ensures collection and/or notification of payment due for services to be rendered; and reaches out to obtain missing information from provider practices such as CPT codes and clinical documentation.

The Coordinator also works and monitors work queues, responds to clinical questions based on chart review interpretation, and functions as a liaison between patients, providers, insurance companies and RHS departments to provide a streamlined pre-registration process of verifying insurance eligibility and benefits, and obtaining authorizations.

• Works closely with nursing, physicians and the pharmacy to ensure authorizations are approved utilizing LCD, MUE and NCCN guidelines.
• Obtains Authorizations for high dollar oncology services, both chemo and non-chemo. Escalates urgent Authorization requests.
• Verifies patient insurance benefits.
• Notifies physician and nursing when drugs fall into "off label" use.
• Provides patient estimates and reviews their benefits. Provides financial estimate for all OCM patients.
• Enrolls patients in Co pay Assist.
• Identifies patients who meet pathways for Anthem or the Oncology Care Model program.
• Works with the follow-up team to resolve any authorization denials.

• High school or equivalent (Required)

• Revenue Cycle (Required)

• Certified Healthcare Access Associate (CHAA) - National Association of Healthcare Access Management (NAHAM) (Preferred)

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