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Clinical Authorization Specialist - Pre-Arrival - Full Time 8 Hour Days (Non-Exempt) (Non-Union)
7 days agoWhat's your preference?
Job Description
- Req#: REQ20165562
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Salary up to $39.69 per hour
- Opportunity for career advancement and growth within the organization
- Supportive and collaborative work environment
- Chance to make a positive impact on patient care and treatment authorization processes
- Engage directly with medical and pharmacy staff to enhance patient experiences
What to Expect (Job Responsibilities):
- Actively obtain written clinical documentation for chemotherapy authorizations from medical and nursing staff
- Submit pre-certification and pre-determination documentation to third-party payers with accurate coding
- Research payer medical policy requirements for chemotherapy treatment authorizations
- Follow up on outstanding authorization requests and medical documentation requests in a timely manner
- Maintain and update medical policy coverage binder with new policies and forms regarding medication usage and authorization requirements
What is Required (Qualifications):
- High school diploma or equivalent
- Minimum of 2 years of experience in a hospital, medical office, or health insurer
- Excellent time management, organizational skills, and communication (written and verbal) abilities
- Strong research, analytical, negotiation, and interpersonal skills
- Completion of Fire Life Safety Training (LA City) within 30 days of hire, if applicable
How to Stand Out (Preferred Qualifications):
- Vocational Nursing Degree or specialized/technical training
- Experience with medical prior authorizations or claims in a managed care setting
- Knowledge of the health insurance industry and claims processing
- Oncology experience
- Licensed Vocational Nurse (LVN) certification in California
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