Medical Precertification Specialist

Job Overview Medical Precertification Specialist – LVN plays a vital role in ensuring timely and accurate authorization of medical services, medications, and treatments, particularly within the oncology field. This position requires specialized knowledge of oncology treatment protocols, medications, and insurance requirements, enabling efficient coordination between healthcare providers, insurance carriers, and patients. Key Responsibilities Precertification and Authorization Evaluate requests for medical services, medications, and treatments with a focus on oncology therapies to ensure compliance with clinical guidelines and insurance requirements. Manage the authorization process for high‑cost medications, chemotherapy regimens, and supportive treatments. Liaise with insurance companies to secure prior authorizations and resolve coverage issues. Clinical Review and Documentation Analyze clinical records and treatment plans to determine medical necessity and appropriateness of care. Ensure all approvals, denials, and related details are accurately documented in the electronic medical record (EMR) system. Utilize knowledge of oncology medications and treatment protocols to support clinical review processes. Communication and Coordination Serve as the primary point of contact between healthcare providers, insurance carriers, and patients for authorization‑related matters. Provide clear and compassionate communication to patients regarding insurance coverage and authorization status. Collaborate with oncology care teams to ensure continuity of care and timely initiation of treatment. Compliance and Updates Maintain compliance with HIPAA and other regulatory standards. Stay informed about updates to oncology treatment guidelines, insurance policies, and coding standards (CPT/ICD‑10). Monitor changes in medication coverage policies, particularly for oncology drugs and supportive care products. Team Collaboration Partner with the oncology care team, pharmacy, billing, and scheduling departments to ensure seamless coordination of care. Contribute to process improvement initiatives within the precertification and authorization workflow. Qualifications Licensure & Experience Active and unrestricted LVN license. Minimum 1‑2 years of clinical experience in a healthcare setting. Preferred: Previous experience with medication authorization, particularly for oncology treatments. Familiarity with oncology treatment protocols and medications, including chemotherapy, immunotherapy, and supportive medications. Knowledge Strong understanding of medical terminology, oncology‑specific treatments, and coding (CPT, ICD‑10). Comprehensive knowledge of insurance requirements for oncology medications and procedures. Skills Excellent analytical and problem‑solving skills. Proficiency in electronic medical records (EMR) systems and Microsoft Office Suite. Strong interpersonal and communication skills, with the ability to explain complex information to patients and providers. Key Competencies Exceptional attention to detail, particularly in clinical and administrative tasks. Ability to manage multiple priorities in a fast‑paced, oncology‑focused environment. Empathy and professionalism when dealing with patients undergoing cancer treatment. Commitment to continuous learning and staying updated on oncology advances and payer policies. Benefits The START Center is open weekdays only and offers nine paid holidays. #J-18808-Ljbffr