The Senior Precertification Specialist will complete the duties of the Precertification Specialists, as well as the following...
- Advanced Case Management: Analyze complex prior authorization cases, proactively identifying potential coverage challenges and working with payers to secure timely approvals.
- Leadership & Mentorship: Serve as a resource for junior team members, providing guidance on payer policies, medical necessity reviews, and best practices. Assist in training new employees.
- Process Optimization: Identify inefficiencies in prior authorization workflows and collaborate with leadership to implement process improvements that support faster authorizations and reduce denials.
- Interdepartmental Collaboration: Act as a liaison between the precertification team, clinical staff, billing department, and scheduling teams, ensuring smooth communication and coordination for authorization-related matters.
- Compliance & Policy Adherence: Maintain up-to-date knowledge of payer policies, Medicare guidelines, and NCCN protocols. Provide recommendations on adjustments to internal procedures to maintain compliance.
- Escalation & Resolution: Handle escalated cases requiring appeals, medical director reviews, and direct payer negotiations for high-priority authorization requests.
Qualifications:
- 3–5 years' experience in a physician practice or healthcare setting performing prior authorization activities, with oncology experience preferred, specifically oncology nursing.
- Extensive knowledge of health insurance regulations, including payer-specific authorization policies.
- Proficiency in ICD-10 and CPT coding, with demonstrated expertise in oncology-related coding and medical necessity review.
- Advanced proficiency in EMR systems, practice management software, and Microsoft Office applications (Outlook, Word, Excel).
- High school diploma or GED required; additional certification in medical billing, coding, or healthcare administration preferred.
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!
