ESSENTIAL DUTIES AND RESPONSIBILITIES
The essential duties and responsibilities of this job include the following. These are the duties that define this job and are required to be performed by the incumbent. Other essential duties may be assigned.
- Perform medical necessity review for services requiring prior authorization to determine medical appropriateness and ensure payer policy guidelines are being met (Medicare, NCCN, payer specific, etc.).
- Obtain COHA Active Treatment Reports from Pharmacy team to initiate medical necessity reviews.
- Recheck medical necessity each quarter
- Perform medical necessity review for services not requiring prior authorization to ensure payer policy guidelines are being met (Medicare, NCCN, payer specific, etc.)
- Maintain all Medicare authorization tasks in Practice Management system (NextGen).
- Document authorization requests completed on a quarterly basis:
- Medical Necessity review
- Meets or does not meet NCCN Guidelines
- Escalate prior authorization issues to directors and/or providers as suitable to determine appropriateness of care and next steps.
- Provide feedback on opportunities to improve the authorization review process and documentation improvement.
- Communicate to billing, scheduling, and/or clinical teams as necessary.
- Contact insurance companies to determine prior authorization requirements
- Utilize technology including payer websites whenever possible
- Communicate with physicians and clinical staff as needed to obtain and/or understand clinical documentation requirements.
- Provide requested/required clinical documentation to payers via phone, fax, and/or website.
- Contact other providers or patients as needed.
- Clearly document and communicate authorization status in relevant systems (practice management, EHR, hospital) including authorization numbers, CPT, HCPCS, ICD-10 codes, dates, and other relevant data.
Other duties that are or may be assigned to this job.
- Understand the critical nature of an Oncology Practice and approach job and responsibilities with a sense of caring and urgency
- Maintain current and detailed knowledge of oncology and related diagnostic services as required to perform job duties
- Deliver outstanding customer service to internal and external customers
- “Add on’s” defined & worked
- Same Day
- STAT(s)
- Perform miscellaneous job duties as assigned
In order to qualify for this job, the incumbent must possess the following qualifications or be able to secure them within 90 days.
- 1-3 years’ experience in a physician practice or other health care setting performing prior authorization activities.
- Knowledge of the health insurance environment with a diversified understanding of patient benefits and varying payer rules and requirements.
- Working knowledge of ICD-10 and CPT coding.
- Strong medical terminology with oncology experience preferred.
- Moderate level of computer skills including EMR (electronic medical record), practice management system, Microsoft Office applications (Outlook, Word, Excel) and use of the internet.
Columbus Oncology Associates is an Equal Opportunity Employer and proudly a Drug-Free Workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.
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What We Do
Our mission is to improve the lives of people affected by cancer and blood disorders. We are committed to providing the highest quality of care for individuals and their loved ones seeking specialized treatment.
For over thirty five years, we have served the greater Columbus area. In our offices, you can expect to find staff members who are friendly and attentive, offering help in an atmosphere of comfort and understanding. For every person who walks through our doors, we believe in providing comprehensive care, and we foster an environment where your questions will be addressed with kindness and promptness.
Our practice specializes in every type of cancer and hematology diagnosis, so when meeting with one of our oncologists, you can feel confident that you are starting a treatment plan with a professional who has years of experience and thorough knowledge in all available options of care. Our physician’s approach is one of patience and respect for every individual’s unique situation, and along with discussing each person’s medical treatment options, we focus on connecting patients with additional outside resources and networks of support that promote holistic health. With years of background serving individuals undergoing cancer or hematology treatment, we understand deeply the anxieties and difficulties that can accompany procedures and therapy plans. Throughout this process, we remain closely connected with our patients, talking through any side effects, reactions, or concerns, and suggesting alternatives when desired.
Ultimately, our goal is to help you feel confident in your treatment plan, our medical professionals, and the latest research and technology we have to offer. Give us a call or visit our website to learn more!
