Job Description

Job Description

Job Description

Salary: 25-30

Purpose of Position:
This position is responsible for obtaining pre-certifications and pre-authorizations for office visits,
radiation therapy treatments, and other referred services. Works closely with the Accounts
Receivable Specialists.

Essential Functions:
• Enter and review patient insurance in EMR for accuracy.
• Contact insurance carriers to verify the patient’s insurance eligibility, benefits, and requirements.
• Triages daily work queue based on patient urgency and modality, while meeting requirements to
submit authorization within a 72-hour timeframe.
• Obtain and secure prior authorization via the payer website or by phone and follow up regularly on
pending cases.
o Secures prior authorization for consultations, scans, and other tests ordered by the radiation
oncology providers.
o Secures prior authorization for complex clinical services such as, brachytherapy, SRS/SBRT,
IMRT, and 3D, and maintains the billable CPT list for each service type.
• Ensures that accurate ICD, CPT codes and related medical records are submitted in the authorization
request.
• Initiate appeals for denied authorizations.
• Respond to clinic questions regarding payer medical policy guidelines.
• Maintain individual payer files to include up-to-date requirements needed to successfully obtain
authorizations.
• Communicate any insurance changes or trends among the team.
• Clearly document all communications and contacts with payers, providers, and personnel in the EMR.

Education, Certification and Licensure:
• High School Diploma or equivalent
• Compliance with annual immunization requirements.
• Coursework in business, medical terminology, or related area is preferred.

Experience:
• No less than one (1) year of medical office experience is preferred.

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