Medical Oncology Prior Authorization Specialist - CCIN
Company: Carle Health
Posted on: January 25, 2023
This position is responsible for obtaining prior authorization
information for the medical oncology department at the Carle Cancer
Institute Normal. If the prior authorization is denied, you will
then work within the patient chart and if necessary, have
discussions with the clinical staff to find an alternate solution.
You will be responsible for submitting appeals. This position is
necessary to ensure patients have the proper coverage for their
treatments and to ensure the department is being paid for the
medical services provided.
- One (1) year of experience in prior authorization and financial
SKILLS AND KNOWLEDGE
omfortable with reading and interpreting patient charts and ability
to work in a busy clinic.Excellent verbal communication and
Microsoft excel experience.
- Assumes primary responsibility working in the department to
provide screening and authorization for appropriate criteria,
pre-certs, third party approval for medical care ordered.
- Obtains documents, verifies and conducts follow-up insurance
authorizations and insurance eligibility as required for scheduled
- Checks Insurance eligibility to ensure that information
provided matches the insurance carriers database information.
- Interacts with external customers to inform and educate
regarding authorization procedures.
- Manages and resolves denied cases In cooperation with the
billing department, works denials by sending appeal letters and
making appropriate contact with Insurance companies or billing
- Generates timely and compliant denial letters and to facilitate
the submission of appropriate appeal documentation.
- Competent in working denials and drafting denial response to
- Answers the department phone as needed.
- other duties as assigned.
- Good communicator and detailed oriented.
- Prints schedules from EMR to review completed
- Works as a member of the department to ensure a team
- Completes all authorizations in a timely manner for proper
scheduling of medical services performed.
- Submitting insurance authorizations through portals, phone, and
We are an Equal Opportunity Employer and do not discriminate
against any employee or applicant for employment because of race,
color, sex, age, national origin, religion, sexual orientation,
gender identity, status as a veteran, and basis of disability or
any other federal, state or local protected class. Carle Health
participates in E-Verify and may provide the Social Security
Administration and, if necessary, the Department of Homeland
Security with information from each new employee's Form I-9 to
confirm work authorization. - For more information:
Effective September 20, 2021, the COVID 19 vaccine is required for
all new Carle Health team members. Requests for medical or
religious exemption will be permitted.
Keywords: Carle Health, Normal , Medical Oncology Prior Authorization Specialist - CCIN, Healthcare , Normal, Illinois
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