Authorization Specialist

Overview Rocky Mountain Cancer Centers, Colorado's largest and most comprehensive provider of cancer care, has an exciting opportunity for an experienced Authorization Specialist in Greenwood Village, CO. We realize that it sounds cliché but it is true – taking care of cancer patients is a calling. It’s much more than a job. Each of us has a unique story that brought us to RMCC, but those stories usually share common themes of care, compassion, and commitment. No matter the role each RMCC team member serves in, the goal is the same: to provide the best care possible for each and every one of our patients. Whether we are a nurse holding our patient’s hand, or a scheduler on the phone finding an appointment that fits into a patient’s schedule, we are deeply connected to our patients and do what we can to help. Responsibilities Review, process, and audit the medical necessity for each patient chemotherapy treatment and documentation of regimen and pathway adherence. Work as a patient advocate and function as a liaison between the patient and payer to answer routine and complex reimbursement inquiries and avoid insurance delays. Obtain insurance authorization and pre‑certification for chemotherapy services. Research additional or alternative resources for non‑covered services to prevent payment denials. Provide a contact list for patients’ community resources including special programs, drugs, pharmaceutical supplies, and financial resources. Communicate with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans. Provide prompt feedback to physicians and management regarding pathway documentation issues and payer issues with non‑covered chemotherapy drugs. Prepare and submit write‑off requests with appropriate documentation. Process insurance/patient correspondence, including denial follow‑up. Maintain reimbursement correspondence and filing systems. Review and process adjustments and refund requests. Assist with review of financial disclosures and negotiated agreement adjustments. Provide coverage for Patient Financial Counselors. Report any problems, issues or payer trends. Maintain a good working knowledge of chemotherapy authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization. Comply with patient confidentiality laws and regulations. Salary Range: $18.29–$26.00 per hour. Benefits (subject to eligibility requirements): health, dental, and vision plans; wellness program; health savings account; flexible spending accounts; 401(k) retirement plan; life insurance; short‑term disability insurance; long‑term disability insurance; Employee Assistance Program; PTO; holiday pay; tuition reimbursement; and employee paid critical illness and accident insurance. Qualifications High school degree or equivalent. Minimum two (2) years medical insurance verification and authorization required. Billing and coding experience preferred. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is occasionally required to stand, walk, and reach with hands and arms. The employee must occasionally lift and/or move up to 30 pounds. Requires vision and hearing corrected to normal ranges. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work is performed in an office environment and involves frequent interaction with patients, clinical and business office staff and payers. All qualified candidates are required to pass a background check and a non‑federal drug test (which excludes marijuana) post‑offer of employment and prior to hire. #J-18808-Ljbffr