Reimbursement Specialist Onc M

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  • JOB SUMMARY
    • Responsible for coordinating the insurance authorization and pre-certification of scheduled medications and labs and communicating the denials as necessary. 
  • DUTIES AND ESSENTIAL FUNCTIONS
    • Overall performance rating of below indicated essential job duties:
    • Responsible for tracking, obtaining & extending authorizations in a timely manner.
    • Records insurance information utilizing standardized documentation practices through the entire pre-cert/authorization process.
    • Obtains, interprets & submits clinical documentation pertinent to the specific services requiring prior authorization to support reviews by the payer.
    • Obtains & documents prior authorization approval from the insurance companies for services and communicates professionally and timely to the provider/clinical staff regarding authorization status or delays. Follows up on denied authorization requests.
    • Facilitates peer-to peer conversations between the insurance carrier and the ordering provider when required to obtain authorizations for services.
    • Provides support to other departments to clarify claim denial appeal efforts.  May work to resolve claims denials related to the prior authorization process.
  • EDUCATION/LICENSE/CERTIFICATION/OTHER REQUIREMENTS
    • Minimum requirement:
      • High School Diploma or GED
      • Must type 35 words per minute
    • Preferred qualifications:
      • Knowledge of medications associated with infusion center
  • WORKING ENVIRONMENT
    • Works indoors in an office/clinic setting
    • The noise level is usually moderate
  • PHYSICAL DEMANDS
    • Constantly required to maintain a stationary position behind a computer.
    • Frequently required to move about inside the department.
    • Constantly required to communicate telephonically and face to face with colleagues and customers.
    • Constantly required to operate a computer and telephone.
    • Constantly required to lift and/or move up to 10 pounds.
    • Frequently required to lift and/or move up to 25 pounds.
    • Occasionally required to lift and/or move up to 50 pounds
    • Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, and depth perception
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