Prior Authorization Coordinator Chemotherapy

Prior Authorization Coordinator Chemotherapy

Requirements

• Comfortable assisting patients with cancer or blood disorders
• Self-motivation and ability to work effectively in an independent environment
• Experience on the payer side reviewing chemo authorizations submitted by the provider
• Attention to detail
• Ability to learn new things quickly
• Experience using EMR systems
• Highly proficient in Microsoft Office particularly Excel, Word, and Outlook
• Work well under deadlines and time pressures
• Results-oriented with a focus on high quality
• High school diploma or GED

Responsibilities

• Coordinate with third-party insurance, clinical staff, and patients to effectively process prior authorization requests for Chemotherapy (IV and Oral), Hydration, IV injections
• Compile clinical documentation for prior authorizations (ex: progress notes, labs, diagnoses codes, previously tried therapies, doctor visits)
• Review authorization queue for applicable orders
• Verify and comply with payer contractual authorization requirements
• Submit authorization request timely and efficiently, ensuring proper documentation is included for review
• Utilize website portal, and electronic options to submit authorization requests
• Submit verbal prescription orders approved by Provider and Medical Director to pharmacies, in conjunction with printed copy
• Work with management to identify payer trends or potential issues
• Demonstrate exceptional customer service skills in the performance of work assignments and duties
• Perform special projects or other duties as assigned
• Maintains confidentiality of patient records

Preferred Qualifications

• Experience performing, reviewing, or generating prior authorizations for procedure or chemotherapy specifically is preferred
• Administrative experience in a physician office, clinic, hospital, or health insurance/ payer is a plus
• CPT and ICD10 Knowledge
• Medical Terminology
• Insurance knowledge; PPO, HMO, Medi-Cal, Medicare, Workers Compensation