Prior Authorization Coordinator, Chemotherapy

Founded in 2007, The Oncology Institute of Hope and Innovation (TOI) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. TOI is dedicated to offering cutting edge, evidence-based cancer care to a population of more than 1.7 million patients including clinical trials, stem cell transplants, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With 100+ employed clinicians and more than 700 teammates in 75+ clinic locations and growing. TOI is changing oncology for the better.

Job Duties for Chemo Authorization Coordinator: 

Coordinate with third-party insurance, clinical staff, and patients to effectively process prior authorization requests for Chemotherapy (IV and Oral), Hydration, IV injections. Compile clinical documentation for prior authorizations (ex: progress notes, labs, diagnoses codes, previously tried therapies, doctor visits). This is one of the most important roles within the organization that allows our patients to receive timely care and TOI's appropriate reimbursement. 

• Review authorization queue for applicable orders 
• Verify and comply with payer contractual authorization requirements 
• Submit authorization request timely and efficiently, ensuring proper documentation is included for review 
• Utilize website portal, and electronic options to submit authorization requests 

• Work with management to identify payer trends or potential issues 
• Demonstrate exceptional customer service skills in the performance of work assignments and duties 
• Perform special projects or other duties as assigned 
• Maintains 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 new things quickly 
• Experience using EMR systems 

• Highly proficient in Microsoft Office particularly Excel, Word, and Outlook 
• Work well under deadlines and time pressures 
• Results-oriented with a focus on high quality. 
• High school diploma or GED 
• Experience performing, reviewing, or generating prior authorizations for procedure or chemotherapy specifically is preferred 

• Administrative experience in a physician office, clinic, hospital, or health insurance/ payer is a plus 
• CPT and ICD10 Knowledge 
• Medical Terminology 
• Insurance knowledge; PPO, HMO, Medi-Cal, Medicare, Workers Compensation