Prior Authorization Coordinator Chemotherapy

Overview

Prior Authorization Coordinator Chemotherapy The Oncology Institute

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Prior Authorization Coordinator Chemotherapy

role at

The Oncology Institute .

Founded in 2007, The Oncology Institute of Hope and Innovation (TOI) delivers highly specialized, value-based cancer care in the community setting. TOI offers cutting edge, evidence-based cancer care with a population of more than 1.7 million patients across 75+ clinic locations and growing, including clinical trials, stem cell transplants, transfusions, and other care delivery models. TOI has 100+ employed clinicians and more than 700 teammates.

At TOI, every decision you make in chemotherapy authorizations directly impacts patient care by ensuring that patients receive timely, medically appropriate treatments while supporting TOIs mission of compassionate, state-of-the-art oncology care.

Job Duties

Coordinate with third-party insurance, clinical staff, and patients to process prior authorization requests for Chemotherapy (IV and Oral), Hydration, IV injections.

Compile clinical documentation for prior authorizations (e.g., progress notes, labs, diagnoses codes, previously tried therapies, doctor visits).

Review authorization queue for applicable orders.

Verify and comply with payer contractual authorization requirements.

Submit authorization requests timely and with proper documentation for review.

Utilize website portal and electronic options to submit authorization requests.

Submit verbal prescription orders approved by Provider and Medical Director to pharmacies, in conjunction with printed copy.

Work with management to identify payer trends or potential issues.

Demonstrate exceptional customer service in the performance of duties.

Perform special projects or other duties as assigned.

Maintain confidentiality of patient records.

Experience / Education

Self-motivation and ability to work effectively in an independent environment.

Experience on the payer side reviewing chemo authorizations submitted by the provider.

Attention to detail; ability to learn quickly.

Experience using EMR systems and highly proficient in Microsoft Office (Excel, Word, Outlook).

Ability to work under deadlines and time pressures; results-oriented with focus on high quality.

High school diploma or GED.

Experience performing, reviewing, or generating prior authorizations for procedures or chemotherapy is preferred.

Administrative experience in a physician office, clinic, hospital, or health insurance / payer is a plus.

CPT and ICD-10 knowledge; Medical Terminology.

Insurance knowledge (PPO, HMO, Medi-Cal, Medicare, Workers Compensation).

The estimate displayed represents the typical wage range of candidates hired. Factors used to determine your salary may include your skills, years of experience, and comparison to other employees in this role.

Pay Transparency

Hourly : $17$20 USD

Seniorit y level

Entry level

Employment type

Full-time

Job function

Other

Industries

Medical Practices

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