Verify and call insurance company to obtain authorization for both Medical and Radiation Oncology services and medications.
· High School Diploma or GED
· 1 to 3 years of prior medical experience preferred
· Customer Service experience
- Develop criteria in Medical Oncology for each major insurance company for chemo and non‑chemo drug coverage. Develop criteria in Radiation Oncology for each major insurance company for various treatment modalities.
- Liaison for both medical and radiation oncology for obtaining prior authorizations for drugs as well as Laboratory Services and Oral pharmaceuticals.
- Documents all communications and insurance authorization information utilizing established systems.
- Work collaboratively with pharmacy and clinical staff and providers to ensure documentation is available.
- Responsible for reviewing all Medicare LCDs and Commercial payer policies related to the combination of treatments to ensure Medical necessity (this includes utilizing Med Assets).
- Follow precertification guidelines for each insurance company such as online applications, faxing, phone calls etc.
- Collaborate with Providers, Patient Accounts, Compliance Team and Manager to review protocol and assist with Clarifying regulatory or policy questions.
- Identify new insurances and work with billing Manager for credentialing purposes.
- Work as consultants for our patient assistance program, which involves meeting patients, reviewing program and working as a liaison between the hospital and the pharmaceutical companies.
- Works in close collaboration with Social Work for all patients needing assistance (free care, free drug and Medicaid services). Reviews cases with social work team members to establish and review plan of care. Advocates for services and funding necessary to meet established outcomes and maintains a working knowledge of the requirements of payers.
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