Chemotherapy Auth Spec

About City of Hope

City of Hope, an innovative biomedical research, treatment and educational institution with over 4000 employees, is dedicated to the prevention and cure of cancer and other life-threatening diseases and guided by a compassionate, patient-centered philosophy.

Founded in 1913 and headquartered in Duarte, California, City of Hope is a remarkable non-profit institution, where compassion and advanced care go hand-in-hand with excellence in clinical and scientific research. City of Hope is a National Cancer Institute designated Comprehensive Cancer Center and a founding member of the National Comprehensive Cancer Network, an alliance of the nation’s 20 leading cancer centers that develops and institutes standards of care for cancer treatment.

Requisition ID: 13933

Job Title: Chemotherapy Authorization Specialist

Location: Irwindale, CA

Position Summary:

Under general supervision verifies insurance eligibility, benefits, verification, prior authorization and researches denied services to ensure payments are processed on a timely basis. Acts as a liaison to ensure accurate processing of all claims. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards.

Key Responsibilities include:

  • Reviews, processes and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen and pathway adherence.
  • Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays. Obtains insurance authorization and pre­certification for chemotherapy services. Researches additional or alternative resources for non-covered services to prevent payment denials. Provides a contact list for patients community resources including special programs, drugs and pharmaceutical supplies and financial resources.
  • Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans. Provides prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered chemotherapy drugs.
  • Prepares and submits write-off requests with appropriate documentation.
  • Processes insurance/patient correspondence, including denial follow-up. Maintains reimbursement correspondence and filing systems. Reviews and processes adjustments and refund requests. Assists with review of financial disclosures and negotiated agreement adjustments. Provides coverage for Patient Financial Counselors. Reports any problems, issues or payer trends.
  • Maintains a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization. Complies with patient confidentiality laws and regulations.
  • Updates coding/payer guidelines for clinical staff. Tracks pathways and performs various other business office functions on an as needed basis.

Minimum Education: High school degree or equivalent.

Minimum Experience: Minimum two (2) years medical insurance verification and authorization required.

City of Hope is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, or status as a qualified individual with disability.

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