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Medical Oncology Prior Authorization Specialist - CCIN

Company: Carle Health
Location: Bloomington
Posted on: January 26, 2023

Job Description:

Position Summary:

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 advocacy.

    ther Requirements
    omfortable with reading and interpreting patient charts and ability to work in a busy clinic.Excellent verbal communication and Microsoft excel experience.

    Essential Functions:

    • 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 exams.
    • 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 staff.
    • Generates timely and compliant denial letters and to facilitate the submission of appropriate appeal documentation.
    • Competent in working denials and drafting denial response to insurance companies.
    • Answers the department phone as needed.
    • other duties as assigned.
    • Good communicator and detailed oriented.
      • Prints schedules from EMR to review completed authorizations.
      • Works as a member of the department to ensure a team environment.
      • Completes all authorizations in a timely manner for proper scheduling of medical services performed.
      • Submitting insurance authorizations through portals, phone, and fax.

        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, Bloomington , Medical Oncology Prior Authorization Specialist - CCIN, Healthcare , Bloomington, Illinois

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