Job Description

Authorization Rep

Cancer care is all we do

Hope in healing

Cancer Treatment Centers of America® (CTCA®) takes a unique and integrative approach to cancer care. Our patient-centered care model is founded on a commitment to personalized medicine, tailoring a combination of treatments to the needs of each individual patient. At the same time, we support patients’ quality of life by offering therapies designed to help them manage the side effects of treatment, addressing their physical, spiritual and emotional needs, so they are better able to stay on their treatment regimens and get back to life. At the core of our whole-person approach is what we call the Mother Standard® of care, so named because it requires that we treat our patients, and one another, like we would want our loved ones to be treated. This innovative approach has earned our hospitals a Best Place to Work distinction and numerous accreditations. Each of us has a stake in the successful outcomes of every patient we treat.

Job Description:

Job Overview

The Precertification Coordinator reviews and evaluates a prospective and current patient’s insurance coverage after obtaining the benefits from patient’s insurance payer. The Coordinator uses the quoted benefit information to facilitate a decision regarding a patient’s eligibility to be treated at the Outpatient Care Centers (OCC), while ensuring that the Patient Financial Acceptance policy and specific OCC exception policies are applied. The Coordinator also provides pertinent information requested from insurance companies and documents authorization details obtained from insurance companies into the OCC database.  The Coordinator will make requests for peer to peer reviews as necessary to obtain authorizations and approvals for service offerings within the Outpatient Care Centers which may include, but are not limited to, chemotherapy, radiation therapy, and imaging.  Proactive documentation and communication for both prospective and current patients is necessary to ensure accurate and complete billing, correct reimbursement rates, pre-certification requirements, and maximized collections. This individual will communicate daily with OIS, OCC staff, Billers, Account Management Specialists and RCM Shared Services.

Job Accountabilities

1.

  • Verifies all new patient verifications and authorizations distributed daily via queues and email request
  • Completes return verifications daily for verifications distributed via the return patient schedules, e-mails and any incoming faxes per established guidelines.
  • Identifies and coordinates patient enrollment in drug replacement programs
  • Obtains benefits and authorizations through a multi-question interview process for physician services for both in and out of network coverage.
  • Documents all information obtained and actions taken for each record in appropriate systems.
  • Maintains all patient’s pre-cert requirements at a minimum of two weeks in advance of current business date
  • Completes a required minimum of records per day.  Provides daily counts via e-mail, and submits daily work per guidelines.
  • Obtains all pertinent clinical information from physician, nursing staff, etc. in-order-to facilitate authorization.
  • Provides additional support during staff shortages due to illness, vacation, etc.
  • Checks every morning for any patient’s orders that were added to a schedule overnight.  Any add on orders will require verification of current orders and perform pre-certification by end of business day.

2. 

  • Evaluates and estimates insurance policy coverage while adhering to the written Patient Financial Acceptance Policy, specific site exceptions by insurance payer, alert list and HIPPA guidelines.
  • Performs initial financial screens through policy interpretation and obtains authorization to maximize reimbursement and minimize the exposure of uncollectible balances.
  • Interprets and communicates insurance benefits and pre-certification requirements based on the different insurance plans, types and groups to OIS, OCC staff, and Billing.
  • Verifies whether-or-not Medicare exists via online verification tools; document information obtained in appropriate systems for each patient verified. 
  • Sends emails to all required personnel regarding: site administration exceptions, benefits changes, coverage termination, and special pre-certification requirements.

3.

  • Advises Supervisor or Director of any updates needed to the insurance verification alert list and any other noticeable insurance trends.
  • Effectively communicates with OCC staff, Patient Accounts, and Supervisor in a professional manner.
  • Participates and completes personal and team goals as assigned
  • Connects with customers (patients, caregivers, co-workers) with a smile or pleasant demeanor.
  • Listens attentively and educates patients and caregivers to ensure their understanding.

Knowledge and Skills

  • Preferably possesses basic knowledge of medical terminology,
  • Preferably possesses good written and verbal communication skills,
  • Must have experience utilizing PC and other office equipment; must have good working knowledge of Operating Systems to include Microsoft Office Suite.
  • Must have ICD-10, CPT knowledge, and ability to read Explanation of Benefits.
  • Highly recommend understanding and experience with insurance terminology
  • Must have outstanding telephone communication and customer service skills. 
  • Possess an in-depth knowledge base regarding regulatory compliance, HIPAA, FMLA, COBRA, Patient Rights, Compliance, EMTALA, Medicare and Medicaid
  • Experience with payer denials, government and payer rules and regulations.
  • Must be able to perform routine mathematical, color coding and alphabetizing functions.
  • Must have excellent organizational skills, and be able to manage multiple priorities and responsibilities. 
  • Must be efficient, reliable, flexible, goal oriented and adaptable to change; while maintaining high productivity levels.  Must be team oriented and able to work independently.

We win together

Each CTCA employee is a Stakeholder, driven to make a true difference and help win the fight against cancer. Each day is a challenge, but this unique experience comes with rewards that you may never have thought possible. To ensure each team member brings his or her best self, we offer exceptional support and immersive training to encourage your personal and professional growth. If you’re ready to be part of something bigger and work with a passionate, dynamic group of care professionals, we invite you to join us. 

Visit:  Jobs.cancercenter.com to begin your journey.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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