Advance Authorization Specialist
Advance Authorization Specialist
Posted on :
19-04-2025
Employer Active
1 Vacancy
Job Alert
You will be updated with latest job alerts via emailValid email field required
Send jobs
Share
Send me jobs like this
Job Alert
You will be updated with latest job alerts via emailValid email field required
Send jobs
Job Description
Description
Primary PurposeThe Advanced Authorization Specialist is responsible for all aspects involved in obtaining highly complex authorizations for a multitude of Inpatient and Outpatient Services. The Advanced 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 Advanced 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 retroactive authorizations and determine root cause analysis.Bachelors Degree or 3 years of authorization experience required.
Primary PurposeThe Advanced Authorization Specialist is responsible for all aspects involved in obtaining highly complex authorizations for a multitude of Inpatient and Outpatient Services. The Advanced 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 Advanced 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 retroactive authorizations and determine root cause analysis.
- 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 highcost treatment and procedures within a short time frame. Expected treatment within 13 days.
- Interpret medical records to determine initial and disease progression to prove medical necessity for ordered services and complete online clinical requests for advanced authorization.
- Manage Atrium Health preferred drug list (chemotherapy/immunotherapy/supportive 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 Molecular Labs and surgeries with payors and Atrium Health Denial Management Teams (HBO/PBO).
Education
Bachelors Degree or 3 years of authorization experience required.
Work Experience
Knowledge / Skills / Abilities
- 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.
- Work requires typing filing use of telephone and sitting for prolonged periods of time.
- Should be able to bend and lift up to 10lbs.
DISCLAIMER
All responsibilities and requirements are subject to possible modification to reasonably accommodate individuals with disabilities.
This job description in no way states or implies that these are the only responsibilities to be performed by an employee occupying this job or position. Employees must follow any other jobrelated instructions and perform any other jobrelated duties requested by their leaders.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
Key Skills
Report This Job
Disclaimer: Drjobpro.com is only a platform that connects job seekers and employers. Applicants are advised to conduct their own independent research into the credentials of the prospective employer.We always make certain that our clients do not endorse any request for money payments, thus we advise against sharing any personal or bank-related information with any third party. If you suspect fraud or malpractice, please contact us via contact us page.
