Job Description

Job Summary

Supports and is responsible for incorporating into job performance the Frederick Health (FH) mission vision core values and customer service philosophy and adheres to the FH Compliance Program including following all regulatory requirements and the FH Standards of Behavior.

The Oncology and Hematology Authorization Specialist is responsible for monitoring obtaining pre-authorizing generating appeals coordinate peer to peer review for phlebotomy IV infusion and oral medications as well as radiology exams and genetic testing.

Example of Essential Functions:

• Will monitor and obtain all pre-authorizations for phlebotomy IV Infusion and oral medication radiology and genetic testing.
• Monitors physician orders to ensure they meet NCCN guidelines.
• Initiates contact with the patient to obtain and review necessary financial documents for qualifying drug assistance programs.
• Maintains strict confidentiality in all dealings related to patients physicians accounts fellow employees
• Communicate with insurance carriers practice staff and patients to obtain the information necessary to obtain authorization.
• Coordinates Peer to Peer reviews with third party payers.
• Generates appeals for chemotherapy denials.
• Generates appeals for oral medication denials.
• Interfaces with contracted payers and FMH finance department
• Provides assistance to other work teams.
• Maintains knowledge of payer rules regulations and changes in authorization process.
• Maintain appropriate level of knowledge of the practice management software by continuous vendor training and third party education (e.g. payers seminars etc.).
• Performs other duties as assigned

Required Knowledge Skills and Abilities:

• Physician billing experience with demonstrated working knowledge of professional fee billing transactions and regulations claims insurance carriers rejection and denial codes error correction and re-posting and contractual adjustments;
• Completion of a high school diploma. College level courses preferred but not required;
• Prior experience and demonstrated competence with patient or customer information systems
• Must be able to define meaningful cause and effect situations related to professional fee claims rejections and denials;
• Demonstrated competency with medical procedural coding (CPT/ICD10);
• Must demonstrate excellent interpersonal skills customer orientation and the ability to interact with personnel of all levels within the organization and work within a multi-disciplinary team environment;
• Excellent oral and written communication;
• Professional manner and attire;
• Ability to clearly articulate administrative processes for policy implementation;
• Must be an intermediate to extensive PC user and be able to maintain (create edit professional output) Microsoft Office products efficiently (Word Excel Power Point).

Minimum Education Training and Experience Required:

• High School Diploma

Patient Contact

Must demonstrate and maintain current knowledge and skills in providing appropriate care/contact for patients in the following age groups:

• Neonate (0 thru 30 days)
• Infant (31 thru 12 months)
• Child (13 months thru 12 years)
• X Adolescent (13 years thru 17 years)
• X Adult (18 years thru 65 years)
• X Geriatric (66 years)

Physical Demands:

Sedentary - Light Work - Lifting up to 15 pounds on an infrequent basis (less than one lift every three minutes). While work is mostly done sitting a certain amount of walking or standing is often necessary.

Ergonomic Risk Factors:

Repetition : Repeating the same motion over and over again places stress on the muscles and tendons. The severity of risk depends on how often the action is repeated the speed of the movement the required force and muscles involved.

Awkward Posture : Posture is the position your body is in and its effect on the muscle groups that are involved in the physical activity. Awkward postures include repeated or prolonged reaching twisting bending kneeling squatting working overhead with your hands or arms or holding fixed positions.

Working Conditions:

Normal Business Office

1. Bloodborne Pathogens Exposure Risk: Category C NO exposure to blood or body fluids.

Reporting Relationship:

Reports to office supervisor.

Caring for you as you care for the CommUNITY
Frederick Health offers a comprehensive and affordable benefits package. Health Dental and Vision insurance are offered the 1st of the month after 30 days of employment to all employees hired to work at least 20 hours per week and we offer multiple plans to best meet your and your familys needs. Life insurance Short-Term Income Replacement and Long-Term Disability are employer paid for eligible employees. Frederick Health offers a robust Paid Time Off program for eligible employees. Our 403B retirement plan helps you save for your retirement and includes an employer match to eligible employees. All employees have access to free financial planning sessions. We also offer an educational assistance program to support your education goals as well as an employer paid Employee Assistance Program.

Pay is based on experience skills and education. If position is part-time salary will be pro-rated based on scheduled hours. The pay range may also vary within the stated range based on specialty if applicable. Non-Exempt positions may have shift differential and/or Overtime paid if applicable.

Hourly: $18.09 -$24.24

Required Experience:

IC

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