Overview
Regional Cancer Care Associates (RCCA) is looking for an exceptional Precertification Specialist to join the team. This position position works to submit authorization for treatment. This position reports directly to the Precertification Supervisor and Billing Manager. Eligibility and patients out of pocket expenses and reviewed. A Precertification Specialist will determine coverage and benefit limits. This position will have direct communication with the patients and their caregivers as well as the division staff, physicians, nurses, and Practice Administrators. The position may refer patients to a Financial Counselor based on their conversations. This individual must also possess strong multi-tasking abilities and bring positivity and passion to their work. If you want to join a team that is on the cutting edge of cancer care, while always putting the patient first, we want to hear from you! While some experience is preferred, we are very open to new grads looking to explore oncology care.
Employment Type: Full Time
Shift Day, no nights or weekends!
Benefits: M/D/V, Life Ins., 401(k)
Location: Sparta, NJ
**This is an on-site position**
Responsibilities
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Verifies insurance eligibility, documents deductible/co-insurance data in systems at the beginning of each month.
- Works with all payers who require authorizations for patient treatments
- Conducts Insurance Benefit Reviews with patients including calculating costs of regimens, assuring patient has a clear understanding of their monetary responsibility
- Coordinates with billing and accounts receivable to collect monetary responsibility from patients at time of service
- Runs daily 3- and 7-day schedules to ensure all precertification requests are approved and the Business Office Note in ONCO is documented and approved for the patients visit.
- Denials are communicated swiftly to the practices
- Missing reports or test results to obtain authorizations are uploaded to portals for approval
- Enters alerts in database and EMR to notify appropriate staff of approval/denials.
- Inputs approvals date ranges and drug codes in Reg Overlay for claims submissions
- Updates all insurance changes as needed
- Follows up on all pending approval requests thru Samacare and contacts patients with approvals/denials.
- Suggests alternative drug from the approved biosimilar list provided from Senior Management
- Coordinates communication of advocacy if needed.
- Involves Billing Manger as needed with difficult issues.
- Reviews daily schedules and monitors orders in EMR for patients requiring insurance authorizations for follow up visits or treatments
- Tracks and updates authorizations for ongoing office follow ups and treatments
- Inputs authorizations and all changes of patient demographics
- Updates all insurance changes
- Follows up on all pending authorization requests to insurance companies
- Contacts patients with authorization approvals
Qualifications
- High school diploma or equivalent required. At least eighteen (18) months front medical office receptionist experience with insurance forms and scheduling software required. Knowledge of this practice's personnel, daily routines, and scheduling a plus.
- Proficiency with computer systems and Microsoft Office (Outlook, Word, and Excel) required.
- Must successfully complete required e-learning courses within 90 days of occupying position.
- Demonstrates adaptability: Handles day to day work challenges confidently; is willing and able to adjust to multiple demands, shifting priorities; demonstrates flexibility.
- Shows work commitment: Sets high standards of performance and works efficiently to achieve them.
- Commits to quality: Emphasizes the need to deliver quality products and/or services.
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US Oncology Network-wide Career Opportunities
401(k)
Nov 10, 2024