Principal Duties and Responsibilities:

  • Receive requests for Medical Oncology/Hematology pre-authorizations and ensure that they are properly and closely monitored
  • Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
  • Follow prior authorization work flow, policies and procedures
  • Collaborate with other departments to assist in obtaining pre-authorizations in a cross functional manner
  • Review accuracy and completeness of information requested and ensure that all supporting documents are present
  • Consult with supervisor or nurse manager to obtain clearance that treatment regimen is considered a medical necessity
  • Process referrals and submit medical records to insurance carriers to expedite prior authorization processes
  • Manage correspondence with insurance companies, physicians, specialists and patients as required
  • Look through denials and submit appeals in a bid to get them approved from insurance companies
  • Create patients’ records and accounts and ensure that pre-authorization information is properly updated in them
  • Secure patients’ demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPPA compliance and regulation