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Advanced Authorization Specialist
| Company | Advocate Health Care |
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| Location | Charlotte, NC, USA |
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| Salary | $21.45 – $32.2 |
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| Type | Full-Time |
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| Degrees | Bachelor’s |
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| Experience Level | Mid Level |
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Requirements
- Bachelor’s Degree or 3 years of authorization experience required.
- General knowledge and background in CPT and HCPCS Coding.
- Must be proficient with medical terminology and be familiar with clinical considerations as these relate to oncology services.
- Excellent written and oral communication skills required.
Responsibilities
- Assess time sensitive Referral Work Queues to obtain highly complex authorizations including IP/OP Chemotherapy, Radiology, specifically related to Oncology treatment plans, IP/OP Surgeries, Molecular and Genetic Laboratory Testing, specialty related PT/OT and Speech Therapy, Psychiatry, Neuro/Psych Evaluations, and Rehab evaluations.
- Manage high volume Stat request mailbox for all oncology facilities for potential life altering, high-cost treatment and procedures within a short time frame. Expected treatment within 1-3 days.
- Interpret medical records to determine initial and disease progression to prove medical necessity for ordered services and complete on-line clinical requests for advanced authorization.
- Manage Atrium Health preferred drug list (chemotherapy/immunotherapy/supportive drugs) with payors and correlate changes with oncology pharmacy.
- Manage Atrium Health drug formulary changes with authorization updates with payors.
- Review laboratory panels for Bone Marrow Biopsies to authorize Molecular Lab Studies, diagnosis specific.
- Review and address monthly denials for Chemotherapy Drugs, Molecular Labs and surgeries with payors and Atrium Health Denial Management Teams (HBO/PBO).
Preferred Qualifications
- Microsoft Excel, Word, Epic experience preferred.
- Databases, hospital registration, billing and clinical systems preferred.
