- Run and work daily Group Inbox / Business Office Report in OncoEMR for procedure/drug order values: Required, Pending, Auth Issue (Onsite), P2P, and Denied for current date of service as well as 5 days out. All STAT orders are to be worked immediately upon request by onsite team.
- Ensure that all aspects of approval have been checked including prior authorization, pre-determination, and pre-certification before approving the order as meeting NYH policy.
- Ensure that all appropriate diagnoses are listed in the patient's summary for drug/procedure order.
- Document in OncoEMR the patient's treatment plan and approval status. Must document all steps taken in research/process of the case
- Communicate with MD and NP's if orders need to be changed on treatment plan or to discuss denials and request letter of medical necessity to appeal authorization denials
- Any patient's that do not have a completed approval status by 4pm EST must be reviewed with management to determine if appointment should be rescheduled.
- Work closely with office and third party vendor to ensure authorizations are in place and insurance benefits are accurate.
- Maintain and ensure the confidentiality of all patient and employee information at all times.
- An authorization specialist will be expected to work when given sufficient notice of required overtime.
- Experience in prior authorizations
- High school or GED required.
- Experience in pharmacy / authorization field.
- Experience working in the healthcare field, preferably in a clinical setting or business office.
- Experience in insurance requirements and medical terminology ICD-10 and CPT coding.
- Experience in billing practice management systems, electronic medical record systems, Microsoft Word, and Microsoft Excel.
- Excellent verbal and communication skills between co-workers, physicians, management staff, patients, insurances, outside programs.
- Ability to multitask, problem solve, utilize basic math skills and follow complex instructions.
- Ability to converse in a calm and friendly manner.
- Able to relate and comfort patients during a difficult time.
- 2 Years authorization experience required.
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Authorization Specialist - Ridge, United States - New York Cancer & Blood Specialists
Description
Authorization SpecialistRidge, NY
New York Cancer and Blood Specialists (NYCBS), a prominent and respected Oncology/Hematology group, is seeking an Authorization Specialist to join a well-established and growing pure sub-specialty practice with academic affiliation. Practice manages a freestanding outpatient Cancer Center with extensive chemotherapy administration, Radiation Oncology, Pharmacy, and Research department.
This position is responsible for verifying benefits of patient's insurance for review of drug and procedure orders for patients within our Interventional Pain & Spine group. Obtain the appropriate authorization for services. They will be responsible for reviewing all orders to ensure treatment plan follows proper insurance guidelines as well as NYH policy. In addition they will be responsible for basic knowledge of billing and scheduling processes. The daily tasks and responsibilities of an Authorization Specialist are listed below.
In this role you will:
Benefits including Tuition Reimbursement, Health Insurance on day 1 of employment, Dental, Vision, Life Insurance, and more.
Check our website at: and follow us on Facebook.
NYCBS is an Equal Opportunity Employer.
