Insurance Authorization Coordinator - Oncology

Newport News, Virginia This position is remote work eligible for candidates residing in the following states: FL, GA, ID, KS, KY, MS, NC, OK, PA*, SC, SD, TN, VA. *Some county exclusions may apply. Overview The Insurance Authorization Coordinator works under the supervision of the Practice Manager and is responsible for researching, follow up and resolving open and pending authorizations in a timely manner. The Insurance Authorization Coordinator obtains, validates and updates insurance information; provides patient financial obligations; reviews insurance benefits; ensures collection and/or notification of payment due for services to be rendered; and reaches out to obtain missing information from provider practices such as CPT codes and clinical documentation. The Coordinator also works and monitors work queues, responds to clinical questions based on chart review interpretation, and functions as a liaison between patients, providers, insurance companies and RHS departments to provide a streamlined pre-registration process of verifying insurance eligibility and benefits, and obtaining authorizations. What you will do Works closely with nursing, physicians and the pharmacy to ensure authorizations are approved utilizing LCD, MUE and NCCN guidelines. Obtains Authorizations for high dollar oncology services, both chemo and non-chemo. Escalates urgent Authorization requests. Verifies patient insurance benefits. Notifies physician and nursing when drugs fall into "off label" use. Provides patient estimates and reviews their benefits. Provides financial estimate for all OCM patients. Enrolls patients in Co pay Assist. Identifies patients who meet pathways for Anthem or the Oncology Care Model program. Works with the follow-up team to resolve any authorization denials. Qualifications Education High school or equivalent (Required) Experience Revenue Cycle (Required) Licenses and Certifications Certified Healthcare Access Associate (CHAA) - National Association of Healthcare Access Management (NAHAM) (Preferred) To learn more about being a team member with Riverside Health System visit us at https://www.riversideonline.com/careers. If loving your work is important to you, consider a career at Riverside. By joining our team, you can make a difference in people's lives. Our mission is to care for others as we would care for those we love. We extend that sense of caring to every patient, resident and customer, as well as to each member of our team. We offer care at all stages of life, in hundreds of locations, giving you room to grow your career, along with great benefits and perks. At Riverside Health, your trust and safety are our top priorities. Unfortunately, job scams are on the rise across the country, and we want to help you feel confident in knowing what is — and is not — part of our hiring process. Learn more about how to recognize a legitimate Riverside job opportunity and what to do if you suspect a scam by visiting this site.

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