Oversees the daily operations for the oncology authorization team in both Medical and Radiation Oncology; including verifying, calling and obtaining authorizations.
- 3 to 5 years in a medical setting
- High School or GED
- Strong customer service skills
- Medical Terminology
- Oversee and coordinate the day-to-day operations and staff.
- Assist in hiring and training new authorization staff and provide performance feedback to Director.
- Responsible for being the liaison between both Medical and Radiation Oncology for obtaining prior authorizations for drugs as well as laboratory services and oral pharmaceuticals.
- Manage special projects such as our patient assistance program, which involves meeting with patients, reviewing programs and working as a liaison between the hospital and pharmaceutical companies.
- Develop and oversee criteria in Medical and Radiation Oncology for each major insurance company for chemotherapy drugs, labs and radiation modalities.
- Document and maintain all communications and insurance authorization information utilizing established systems.
- Responsible for the oversight of all Medicare LCDs and Commercial payer policies related to the combination of treatments to ensure medical necessity (this includes NThrive).
- Follow pre certification guidelines for each insurance company such as on line applications, faxing, telephone calls, etc.
- Coordinate the collaboration between providers, patient accounts, compliance team and manager to review protocol and assist with clarifying regulatory or policy questions.
- Update bench marking as needed.