Clinical Authorization Specialist (Hospital) - PreArrival - Full Time 8 Hour Days (Non-Exempt) (Non-Union)
Core
Securing medical authorizations from third-party payers for outpatient, inpatient, and chemotherapy treatments.
Role type
Clinical Authorization Specialist (Oncology)
Builds
Authorization workflows for chemotherapy and infused treatments
Domain
Healthcare administration / Oncology
Deliverable
client delivery
Required skills
Medical policy research, CPT/ICD coding, Excel macro tracking, patient assistance program enrollment, compliance scanning, denied claim coordination
Preferred skills
Vocational Nursing Degree, Oncology experience, Managed care prior authorization experience, Health insurance claims processing knowledge, Licensed Vocational Nurse (LVN)
Technologies
Keckcare, Excel Macro, Compliance checker, Financial systems
Responsibilities
Obtain clinical documentation for chemotherapy authorizations, Submit pre-certification documentation to payers with correct coding, Research payer medical policy requirements, Track and report authorization outcomes daily, Follow up on outstanding requests and documentation, Enroll patients in manufacturer assistance programs, Coordinate with Director on denied/disputed claims, Maintain medical policy coverage binder, Document authorization outcomes in financial systems
Seniority
Individual Contributor, 2+ years experience