Chemotherapy Insurance Authorization Specialist

Position Summary: This position is responsible for obtaining benefits and prior authorizations for scheduled treatments/procedures. Responsible for educating patient on insurance coverage and benefits. Assess patients’ financial ability; may educate patient on assistance programs.

Essential Duties and Responsibilities

The essential functions include, but are not limited to the following:

• Prior to a patient receiving treatment; obtains insurance coverage information and demographics; educates patient on insurance coverage, benefits, co-pays, deductibles, and out-of-pocket expenses.
• Responsible for acquiring and documenting all Prior Authorizations need for patients before first visit.
• Assess patients’ ability to meet expenses and discusses payment arrangements.
• May educate patients on financial assistance programs as well as identify sources and provide assistance with completing forms.
• Based upon diagnosis, estimated insurance coverage, and financial assistance, completes Patient Cost Estimate form.
• Completes appropriate reimbursement and liability forms for patient’s review and signature. Forwards appropriate information and forms to billing office.
• Responsible for obtaining, from Clinical Reviewer, insurance pre-authorization or referral approval codes prior to each treatment.
• Review patient account balance and notify front desk of patients to meet with
• Ensure that patient co-pay amount is correctly entered into system (or conveyed), allowing front desk to collect appropriately
• At each patient visit, verifies and updates demographics and insurance coverage in computer system according to Standard Operating Procedures (SOPs).
• Stays current on available financial aid. Develops professional relationships with financial aid providers. Networks with financial aid providers to obtain leads to other aid programs.
• Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patient’s records.
• Maintains updated manuals, logs, forms, and documentation.
• Other duties as requested or assigned.

Qualification/Requirement:

• Excellent computer skills. Must be able to work effectively with common office software and medical records software.
• Requires the ability to perform basic math functions and to assemble data into reports using spreadsheet programs.
• Must have the ability to handle confidential information and sensitive issues.
• Must be able to work under minimal supervision and make independent decisions using good judgment.
• Requires excellent communication, human relations, attention to detail and organizational skills.
• Requires the ability to multi-task activities.
• Must be able to communicate effectively to various ethnic and cultural backgrounds obtaining necessary resources when language barriers present.
• Requires the ability to perform efficiently with some analytical/problem solving skills.
• Ability to apply a common sense understanding to carry out detailed and involved written and/or oral instructions.
• Ability to deal with problems involving occasional, last-minute changes in generally standardized situations.

Education/Training/Experience:

• High school diploma or a GED.
• Six months related experience and / or training.
• Knowledge of EMR, medical terminology, ICD-10 and CPT codes.