Overview:
The Chemo Authorization Specialist serves as a billing and processing coordinator for chemotherapy within the organization. Working under some supervision, this position verifies insurance eligibility, benefits, verification, prior authorization and researches denied services to ensure that payments are processed on a timely basis.
Responsibilities:
- Represents patients to payer (insurance) to make certain that payments are received on time and the patient is able to receive necessary treatment.
- Reviews and audits the medical necessity of chemotherapy for patients, documenting their treatment plan to confirm that they should be receiving chemotherapy and maintaining medical records for other staff to easily access.
- Researches alternative coverage options, in the case of an inability to pay, that best fit the patient's profile to raise the quality of care above what the patient would otherwise be able to receive.
- Works with financial counselors to help provide community resources to work with the patient during a difficult financial and medical period.
- Communicates with medical staff to inform them of any restrictions or special requirements in accordance with the particular insurance plans to confirm that the patient is able to be treated correctly, and that the organization is able to receive payment from insurance companies.
- Performs other duties as assigned.
Qualifications:
EDUCATION:
Required: High School Diploma or equivalent
EXPERIENCE:
Required: 5 Years of Experience in medical insurance verification and authorization
LICENSURE/CERTIFICATION/REGISTRY/LISTING:
