Located in the heart of the Coachella Valley, you have access to resort-style living and world-class amenities throughout Southern California.
Job Description:
Education:
Required: High school diploma, GED or higher level degree
Licensure/Certification:
N/A
Experience:
Preferred: Experience reviewing medication authorizations in a medical office; experience working with EMR systems; experience in oncology
Job Objective:
Under the supervision of the Business Office Manager, submits requests for medication authorization to insurance companies and provides documentation to support complex infusion treatments.
Essential Responsibilities:
- Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.
- Ensures the accurate and timely processing of injection and infusion orders.
- Works with third-party insurance representatives and EMC clinical staff to process prior authorization requests for infusions and injections.
- Obtains required clinical documentation for prior authorization (ex: progress notes, labs, diagnoses codes, previous therapies, etc.), ensuring all needed clinical records are collected in order to have treatment authorized on the first attempt.
- Reviews authorization queue for orders and makes sure the schedule is clear for the coming days.
- Observes payor contractual authorization requirements.
- Utilizes website portals and electronic options (when available) to submit authorization requests. Employs other communication sources when required by the payor.
- Works with management to identify payor trends, preferred medications, biosimilars and/or generics.
- Performs other duties as assigned.
Essential Skils:
- Strong computer skills
- Ability to effectively communicate and write clearly
- Exceptional customer service skills
- Self-starter; driven to take action without needing prompting
- Insurance knowledge, both government and commercial
