Authorization Specialist

One Oncology is positioning community oncologists to drive the future of medical care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer and other diseases. Our team is bringing together leaders to the market place to help drive One Oncology’s mission and vision.

Why join us? This is an exciting time to join One Oncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, urology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of independent physicians and the patients they serve.

Role

Summary:

The Authorization Specialist role is responsible for all administrative aspects of outpatient diagnostic testing and procedure benefit verification and authorization. This role will ensure patient’s insurance requirements for reimbursement before diagnostic testing or procedure. Obtains pre-authorizations for Physician Orders for diagnostic testing or procedure as required by the patient’s insurance carrier. Ensure the financial feasibility of treating each patient in our clinics by communicating and working closely with patients, physician, nurse and social worker.

Work in specific areas of concern in the department on a project basis. Assist Patient Finance Manager in training staff, projects and implementations. Maintain in-depth knowledge of authorization process as well as reimbursement methodologies. Maintain knowledge of collection techniques and collection laws.

• Obtains pre-authorizations for Physician Orders for diagnostic testing or procedure as required by the patient’s insurance carrier.
• Communicates with physician/clinical staff on reimbursement issues and/or pre-certification requirements by the patient’s insurance carriers.
• Ensures up-to-date documentation on patient’s accounts in Electronic Medical Record on authorization approvals and denials.
• Communicates with Insurance Authorization Coordinators the need for updated referrals.
• Communicates with front office manager and staff in the case of denials that will require rescheduling and/or peer-to-peer review by the ordering physician.
• Communicates with hospitals or other diagnostic facilities to correct any discrepancies.
• Contacts Insurance Authorization Coordinators to notify of termed insurances.
• Communicates as necessary and in a timely fashion with Front Office and imaging center staff with regards to the status of pending authorizations.
• Contacts Clinical Trial team to notify of denied scans for patients on study to verify coverage of scan by study.
• Keeps current on insurance carrier requirements for diagnostic testing and procedures.
• Follows policy and procedures outlined by management to ensure standardization of processes across the clinics.
• Additional responsibilities may be assigned to help drive our mission of improving the lives of everyone living with cancer.
• Lab Information System, Pharmacy Information System, Entire Chart/Electronic Medical Record (EMR), Electronic Billing System (EBS).
• Works denial worklist completing retro authorization request and or medically necessary appeals.
• Review payer guidelines for medically necessity guidelines including frequency and prior testing requirements.

• High School diploma or equivalent.
• 1+ year(s) of Prior Authorization experience.
• Medical insurance background required.

• Attendance is an essential job function.
• Ability to work effectively with all levels of management and other colleagues
• Ability to demonstrate initiative and mature judgment.
• Ability to…