Precertification Specialist

Regional Cancer Care Associates (RCCA) is looking for an exceptional Precertification Specialist to join the team. This position position works to submit authorization for treatment. This position reports directly to the Precertification Supervisor and Billing Manager. Eligibility and patients out of pocket expenses and reviewed. A Precertification Specialist will determine coverage and benefit limits. This position will have direct communication with the patients and their caregivers as well as the division staff, physicians, nurses, and Practice Administrators. The position may refer patients to a Financial Counselor based on their conversations. This individual must also possess strong multi-tasking abilities and bring positivity and passion to their work. If you want to join a team that is on the cutting edge of cancer care, while always putting the patient first, we want to hear from you! While some experience is preferred, we are very open to new grads looking to explore oncology care.

Employment Type: Full Time

Location: Sparta, NJ

As of the date of this posting, RCCA offers a comprehensive benefits package for this position, subject to eligibility requirements. In addition to the salary, we provide: 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 (EAP), Paid Time Off (PTO) and holiday pay, Tuition discounts with numerous universities.

We believe these benefits underscore our commitment to the well-being and professional growth of our employees.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Verifies insurance eligibility, documents deductible/co-insurance data in systems at the beginning of each month.
• Works with all payers who require authorizations for patient treatments
• Conducts Insurance Benefit Reviews with patients including calculating costs of regimens, assuring patient has a clear understanding of their monetary responsibility
• Coordinates with billing and accounts receivable to collect monetary responsibility from patients at time of service
• Runs daily 3- and 7-day schedules to ensure all precertification requests are approved and the Business Office Note in ONCO is documented and approved for the patients visit.
• Denials are communicated swiftly to the practices
• Missing reports or test results to obtain authorizations are uploaded to portals for approval
• Enters alerts in database and EMR to notify appropriate staff of approval/denials.
• Inputs approvals date ranges and drug codes in Reg Overlay for claims submissions
• Updates all insurance changes as needed
• Follows up on all pending approval requests thru Samacare and contacts patients with approvals/denials.
• Suggests alternative drug from the approved biosimilar list provided from Senior Management
• Coordinates communication of advocacy if needed.
• Involves Billing Manger as needed with difficult issues.
• Reviews daily schedules and monitors orders in EMR for patients requiring insurance authorizations for follow up visits or treatments
• Tracks and updates authorizations for ongoing office follow ups and treatments
• Inputs authorizations and all changes of patient demographics
• Updates all insurance changes
• Follows up on all pending authorization requests to insurance companies
• Contacts patients with authorization approvals

QUALIFICATIONS:

• High school diploma or equivalent required. At least eighteen (18) months front medical office receptionist experience with insurance forms and scheduling software required. Knowledge of this practice's personnel, daily routines, and scheduling a plus.
• Proficiency with computer systems and Microsoft Office (Outlook, Word, and Excel) required.
• Must successfully complete required e-learning courses within 90 days of occupying position.
• Demonstrates adaptability: Handles day to day work challenges confidently; is willing and able to adjust to multiple demands, shifting priorities; demonstrates flexibility.
• Shows work commitment: Sets high standards of performance and works efficiently to achieve them.
• Commits to quality: Emphasizes the need to deliver quality products and/or services

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. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.

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. Exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment may occur