Responsibilities
Manage Prior Authorization Process: Oversee the entire prior authorization process for oncology treatments, procedures, and medications, ensuring timely and efficient approvals
Review Requests: Evaluate prior authorization requests to confirm they meet medical necessity criteria and payer guidelines
Collaborate with Care Teams: Work closely with oncologists, nursing staff, and billing teams to gather necessary clinical documentation and ensure it is submitted accurately and promptly
Insurance Coordination: Coordinate with insurance companies to resolve coverage issues, denials, and appeals, ensuring that patients receive the care they need without unnecessary delays
Record Keeping: Maintain accurate records of all prior authorization requests, including approvals, denials, and appeals, ensuring documentation is compliant and well-organized
Proactive Problem Resolution: Identify and address barriers to timely approvals, proactively addressing payer-spe...