Authorizations Specialist- Pediatric Hematology/Oncology

Job Description

Job Description

SUMMARY: The Authorizations Specialist is responsible for obtaining authorizations and referrals for our pediatric hematology/oncology office.

• Inputs new patient information and updates information in our EMR system
• Analyzes patient records and insurance policies to determine if procedures, treatments, or medications require prior authorization
• Ensure patients are eligible for services and that insurance benefits are accurate
• Notifies providers of potential coverage options
• Communicates with patients about the authorization process and any potential delays or financial implications.
• Interacts with healthcare providers, insurance companies, and patients to obtain and provide information needed for authorization decisions
• Compiles and submits detailed authorization requests to insurance companies, including all necessary documentation
• Completes/obtains authorizations and referrals for services, including appointments, procedures, infusions, and medications
• Researches and resolves any issues or discrepancies related to authorization requests
• Monitors and follows up on authorization requests to ensure timely processing
• Investigates insurance denials and resubmit requests or appeals when necessary.
• Monitors schedule for potential issues
• Remains informed about healthcare industry regulations, trends and insurance policies
• Performs other related duties as assigned by management.

QUALIFICATIONS:

• High school diploma or general education degree (GED), or one to three months related experience and/or training, or equivalent combination of education and experience. Associate degree a plus.
• Strong understanding and experience in medical billing or insurance authorization.
• Knowledge of medical terminology.
• Ability to use Microsoft Office- Outlook, Word, Excel,
• Acute attention to detail and strong organization skills.

OTHER COMPETENCIES:

• Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
• Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.
• Innovation - Displays original thinking and creativity; Meets challenges with resourcefulness; Generates suggestions for improving work; Develops innovative approaches and ideas; Presents ideas and information in a manner that gets others' attention.
• Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
• Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; Supports organization's goals and values; Benefits organization through outside activities; Supports affirmative action and respects diversity.
• Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
• Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.