PreAccess Oncology Benefits/Auth Special

Day (United States of America)

601 E Rollins St

Orlando

Florida

32803

Alerts physician offices to issues with verifying insurance and communicates situations where medical necessity is not met. Reviews clinical records when following up on authorization requests directly with payors. Obtains initial and subsequent pre-authorizations for chemotherapy treatments and research protocols, noting approvals in the electronic medical record. Contacts insurance companies to obtain and verify insurance eligibility and benefits within established timeframes. Other duties as assigned. Reviews chemotherapy regimen/treatment orders and determines insurance benefits and authorization requirements. Reviews clinical data such as patient pathology reports, scans, laboratory results, and prior treatments against insurance payor and most appropriate guidelines. Reviews clinical data such as patient pathology reports, scans, laboratory results, prior treatments, matching against insurance payor and/or National Comprehensive Cancer Network (NCCN) guidelines. Responsible for communicating to service line partners of situations where medical necessity is not met to include review of journal articles, compendia and/or peer review to justify medical necessity approval Reviews clinical records when following up on authorization request directly with a payor. Ensures specified medical terms, diagnosis, medication codes, and supporting clinical documentation are met. Facilitates the sending of clinical information in support of authorization to payor or third-party administrators. Reviews medical records to confirm treatment is supported by approved medical studies. Stays current on payer preferences for biosimilar drugs and ensures patient orders are updated accordingly. Ensures each treatment is coded, reviewed, and financially cleared based on patient insurance requirements. Verifies medical necessity in accordance with CMS standards and communicates relevant coverage/eligibility information to patients.

$17.80 - $28.48

Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law.

Applicants may review general information about Florida’s background screening requirements at the Florida Care Provider Background Screening Clearinghouse:
https://info.flclearinghouse.com/

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.