Precertification Specialist

Overview

oin the team at Regional Cancer Care Associates as a Precertification Specialist, where your passion and multi-tasking prowess will directly impact patient lives! Be the vital link in securing treatment authorizations, collaborating with our dynamic healthcare team, and guiding patients through their financial journeys. Whether you're an experienced professional or a fresh graduate ready to dive into oncology care, this is your chance to make a meaningful difference. Step into the forefront of cancer care and help us transform lives today!

Employment Type: Per Diem

Location: Remote

Compensation: $19.50 - 26.29 per hour

Compensation packages based on your unique skills, experience, and qualifications

Responsibilities

• Monitors assigned worklists and emails to provide front end review for authorization and to answer any questions related to authorizations.
• Contacts patients to discuss OOP cost, offer assistance options (if available), and coordinate outreach for patient plan initiation (if applicable).
• Reviews weekly denial report, resolves issues including submitting retro authorization requests or front-end appeals.
• Adheres to workflow and if issues arise escalates to Supervisor promptly.
• Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regard to patient records.
• Performs 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 able to multitask efficiently.
• Must successfully complete required e-learning courses within 90 days of occupying position
  
  

Competencies

• Uses Technical and Functional Experience
• Possesses up to date knowledge of the profession and industry
• Accesses and uses resources when appropriate
• Demonstrates Adaptability
• Handles day to day work challenges confidently
• Is willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change
• Shows resilience in the face of constraints, frustrations, or adversity
• Demonstrates flexibility
• Customer Service o Demonstrates positive interpersonal relations in dealing with fellow employees, supervisors, physicians, patients as well as outside contacts so that productivity and positive employee/patient relations are maximized.
• Uses Sound Judgment
• Makes timely, cost effective, and sound decisions
• Makes decisions under conditions of uncertainty
• Shows Work Commitment
• Sets high standards of performance
• Pursues aggressive goals and works efficiently to achieve them
• Commits to Quality
• Emphasizes the need to deliver quality products and/or services
• Defines standards for quality and evaluates products, processes, and services against those standards
• Manages quality
• Improves efficiencies
  
  

Physical Demands

The physical demands described here are representative of those that must be met by an 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. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment may occur.