Sr. Authorization Specialist

OneOncology is positioning community oncologists to drive the future of cancer care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer. Our team is bringing together leaders to the market place to help drive OneOncology’s mission and vision.

Why join us? This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of community oncologists and the patients they serve.

Job Description:

The Sr. Authorization Specialist will be responsible for orienting, training, and mentoring new employees during the on boarding process. The Sr. Authorization Specialist will be knowledgeable in their respective team roles and serve as the main point of contact for new employees.  The Sr. Authorization Specialist will be a liaison between Patient Accounting staff, management, and director to ensure effective communication.   

Responsibilities:  

• Obtains pre-authorizations for Physician Orders for diagnostic testing or procedure as required by the patient’s insurance carrier.

• Communicates with physician/clinical staff on reimbursement issues and/or pre-certification requirements by the patient’s insurance carriers.  

• Ensures up-to-date documentation on patient’s accounts in Electronic Medical Record on authorization approvals and denials. 

• Communicates with Insurance Authorization Coordinators the need for updated referrals. 

• Communicates with front office manager and staff in the case of denials that will require rescheduling and/or peer-to-peer review by the ordering physician. 

• Communicates with hospitals or other diagnostic facilities to correct any discrepancies. 

• Contacts Insurance Authorization Coordinators to notify of termed insurances. 

• Communicates as necessary and in a timely fashion with Front Office and imaging center staff with regards to the status of pending authorizations. 

• Contacts Clinical Trial team to notify of denied scans for patients on study to verify coverage of scan by study. 

• Keeps current on insurance carrier requirements for diagnostic testing and procedures. 

• Follows policy and procedures outlined by management to ensure standardization of processes across the clinics. 

• Additional responsibilities may be assigned to help drive our mission of improving the lives of everyone living with cancer. 

• Lab Information System, Pharmacy Information System, Entire Chart/Electronic Medical Record (EMR), Electronic Billing System (EBS).   

• Works denial worklist completing retro authorization request and or medically necessary appeals. 

• Review payer guidelines for medically necessity guidelines including frequency and prior testing requirements. 

Required Qualifications: 

• High School diploma or equivalent. 

• One year experience in a directly related role preferred, but not required.  

• High School diploma or equivalent required. 

• 1+ year(s) of Prior Authorization experience. 

• Medical insurance background