Charlotte, NC, United States
Job ID: 11862
Job Family: Patient Accounting/Registration
Status: Full Time
Shift Details: Regular
Department Name: 11011039132957-Oncology - Pediatric
Location: MCP - 1001 Blythe Blvd
The Advance Authorization Specialist is responsible for all aspects involved in obtaining highly complex authorizations for a multitude of In-patient and Out-patient Services. The Advance Authorization Specialist must be knowledgeable and have a thorough understanding of Commercial and Government payors with regards to Coordination of Benefits, Authorization guidelines, Pharmacy and Medical Benefit variances, as well as Medical Necessity Policies. The Advance Authorization Specialist is responsible for reading and interpreting various complex medical records to obtain authorizations for requested services and treatment plans. Communication with clinic staff, providers, Pharmacists, and insurance companies is essential to ensure completed peer reviews, relay updated medical and specialty drug policies, and appeals. They work closely with the Hospital and Provider Denial Management Teams to review monthly denials and assess opportunities for retro-active authorizations and determine root cause analysis.
Work requires typing, filing, use of telephone and sitting for prolonged periods of time.
Should be able to bend and lift up to 10lbs.
Education, Experience and Certifications
Bachelor’s Degree or 3 years of authorizations experience in oncology 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. Microsoft Excel, Word, Epic experience preferred. Databases, hospital registration, billing and clinical systems preferred.