[Hiring] Precertification Specialist @The US Oncology Network

Role Description

Join RCCA and make a meaningful impact on the patient journey. As a fully remote Precertification Specialist, you will be responsible for obtaining and managing prior authorizations to ensure patients receive timely access to the care and treatment they need. This role requires strong attention to detail, problem-solving skills, and a commitment to delivering exceptional service while navigating complex insurance requirements.

• Under general supervision, ensure that prior authorizations are obtained in a timely manner and remain current, facilitating uninterrupted patient care.
• Review and confirm patient insurance eligibility, benefits, and coverage for specific services, ensuring alignment with payer requirements.
• Follow standard operating procedures and established guidelines to complete tasks related to prior authorization, ensuring compliance and accuracy.
• Proactively follow up with insurance carriers on pending or denied authorizations, submitting appeals when necessary.
• Resolve any issues or discrepancies related to prior authorization requests.
• Support and adhere to the US Oncology Compliance Program, including the Code of Ethics and Business Standards and US Oncology's Shared Values.
• Monitor assigned worklists and emails to provide front-end review for authorization and to answer any questions related to authorizations.
• Contact patients to discuss OOP cost, offer assistance options (if available), and coordinate outreach for patient plan initiation (if applicable).
• Review weekly denial report and resolve issues, including submitting retro authorization requests or front-end appeals.
• Adhere to workflow and escalate issues to Supervisor promptly.
• Adhere to confidentiality and all state, federal, and HIPAA laws and guidelines regarding patient records.
• Perform other duties as requested or assigned.

Qualifications

• High School diploma or equivalent required.
• Minimum two (2) years of experience in a patient access or financial clearance role. Oncology preferred.
• Demonstrate advanced knowledge of medical terminology.
• Ability to navigate different systems seamlessly and multitask efficiently.
• Must successfully complete required e-learning courses within 90 days of occupying position.

Requirements

• Technical and Functional Expertise: Maintains current knowledge of healthcare reimbursement, insurance authorization requirements, industry standards, and applicable regulations.
• Adaptability and Resilience: Demonstrates flexibility and adaptability in a fast-paced healthcare environment.
• Customer Service Excellence: Builds and maintains positive working relationships with patients, physicians, coworkers, supervisors, insurance carriers, and other external partners.
• Judgment and Decision-Making: Exercises sound judgment when evaluating information, resolving issues, and determining appropriate courses of action.
• Accountability and Work Commitment: Takes ownership of responsibilities and follows through on commitments.
• Quality and Continuous Improvement: Consistently delivers high-quality work and services with a focus on accuracy and compliance.

Benefits

• Health, dental, and vision plans.
• Wellness program.
• Health savings account - Flexible spending accounts.
• 401(k) retirement plan.
• Life insurance.
• Short-term disability insurance.
• Long-term disability insurance.
• Employee Assistance Program (EAP).
• Paid Time Off (PTO) and holiday pay.
• Tuition discounts with numerous universities.