Prior Auth Specialists

Carolina Oncology Specialists has been caring for patients in Catawba County since 1983, offering patients high quality, personalized healthcare close to their own home so patients and caregivers don’t have to travel far for excellent care. Our patients experience the convenience of in-clinic chemotherapy treatments, as well as the treatment and management of blood disorders.

Why Join Us? We are looking for talented and highly-motivated individuals who demonstrate a natural desire to support the meaningful work of community oncologists and the patients we serve.

Job Description:

General Summary: Verify Benefits for commercial, government, and all third-party payers to include Infusion and Injection procedures/ medications.

Essential Job Responsibilities:

• Set daily priorities and timely perform benefit verification and accurate precertification via verbal and/or written inquiries to insurance carriers.
• Responsible for executing and maintaining the appropriate processes to verify patient eligibility and benefits (determining patient financial responsibility) for services provided.
• When necessary, gather information from the patient, provider, employer, or insurance carrier to complete necessary verification. Update the patient chart when needed. Alert billing department via tasking to fix any dates of services not billed to correct carrier.
• Determine benefits and prepare financial estimate for infusion/ injection for financial counseling team to be able to discuss the patient’s benefits with the patient.
• Enter authorization in the appropriate places in PM and EHR for the nursing and billing teams to be able to perform the infusion.
• Perform various clerical tasks to expedite the verification process, including but not limited to reviewing chart notes and demographic information.
• Verify benefits at the beginning of each month or when necessary to confirm patient eligibility for recurring infusion/ injections.
• Fill in when short-staffed, help when needed with workload/volume.
• Check payer and drug manufacturer websites for updates to coverage or prior authorization requirements monthly.
• Always maintain patient confidentiality as defined by state, federal, and company regulations and apply the highest standards of ethical conduct and decision-making.
• Collaborate with the infusion department and precertification department staff when difficulties or challenges arise from payers to come up with a resolution for the best patient care.
• Respond to internal tasks and emails in a timely manner.
• Communicate time off needs to the precertification team and work together for coverage prior to submitting PTO requests.
• Ability to work calmly and respond professionally while working under pressure.
• Apply the highest standards of ethical conduct.
• Perform other duties and responsibilities as assigned.

Education: High school diploma or equivalent.

Experience: 1 year of customer service, preferably in the medical industry. Medical Billing, Coding, or clinical administrative experience.

Other Requirements: Strong interpersonal and communication skills, an investigative nature and pleasant disposition and phone presentation.

Performance Requirements:

• Knowledge of and familiarity with CPT and ICD-9 diagnostic codes.
• Knowledge of medical and insurance terminology.
• Knowledge of insurance and benefits structure.
• Skill in investigative communication and gathering and reporting information.
• Skill in computer applications, including Microsoft Outlook. Excellent verbal and written communication skills.
• Ability to maintain a pleasant phone presentation and deal with emotionally charged situations.
• Ability to be detail-oriented and work independently.
• Ability to meet short-term deadlines and multitask in a fast-paced environment.
• Ability to make a high volume of outbound calls.

Equipment Operated: Standard office equipment, including computers, fax machines, copiers, printers, telephones, etc.

Work Environment: Position is in a well-lighted, well-ventilated office environment. Occasional evening and weekend work.

Mental/Physical Requirements: The physical demands described here are representative of those that must be met by an office employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to use hands to finger, handle or feel and reach with hands and arms. The employee is frequently required to sit for lengthy time periods, use a keyboard, use a telephone and other office equipment, climb stairs multiple times a day, communicate in both oral and written forms, and talk or hear. The employee is occasionally required to stand, walk, and climb or balance. Lifting items weighing less than 25 pounds is occasionally required. Rarely is there a need to lift more than 50 pounds.

AAP/EEO Statement. Carolina Oncology Specialists is an equal opportunity employer.