Specialist-Authorization Denial in Memphis, Tennessee, United States
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Specialist-Authorization Denial
Job ID: 41380
Job Category: Administrative Non Clinical Support
Work Type: Full Time
Work Schedule: Days
Department: Denial Mitigation
Facility: BMHCC System Services
Location: Memphis, TN
Overview
Summary
Authorization Denial Specialist ensures that chemotherapy (specialty group) and other infusions/radiation therapy/radiology/ surgical services meet medical necessity and appropriateness per insurance medical policies/ FDA/NCCN guidelines. Initiates and coordinates pre-certifications/prior authorizations per payer guidelines prior to services being rendered and completes the Insurance verification process.
Reviews clinical information and supporting documentation for outpatient or Part B services authorization denials to determine and perform retro authorizations, reconsiderations or appeal actions to defend the revenue. Performs other duties as assigned.
Responsibilities
Requirements, Preferences and Experience
Minimum Required
3 - 5 years of business experience in a healthcare environment with 2 of those years being in a clinical setting.
Preferred/Desired
5 years of business experience in a healthcare environment with at least 3 years payer specific experience.
3 years clinical experience in a clinical care setting
Pre-certification experience desired.
Education
Minimum Required
Skill in communicating clearly and effectively using standard English in written, oral, and verbal format to achieve high productivity and efficiency. Skill to write legibly and record information accurately as necessary to perform job duties. Strong organizational skills. Ability to type and/or key correctly
Preferred/Desired
Associates degree or 2 years of college level courses.
Training
Minimum Required
Requires critical thinking and judgement.
Preferred/Desired
Must demonstrate the ability to appropriately use standard criteria established by payers.
Special Skills
Excellent customer service and communication skills. Ability to speak, articulate, and be understood clearly.
Minimum Required
Ability to read and understand medical policies, compendiums, LCDs, and FDA guidelines. Must be able to multi-task and be flexible. Advance computer literacy skills and problem-solving skills. Ability to deal with confrontational issues and high stress situations with patients, family, and physicians.
Preferred/Desired
Knowledge of oncology pre-certification requirements and guidelines.
Licensure
Preferred/Desired
Pharmacy Tech, CHAA, RHIT, LPN, RN
About Baptist Memorial Health Care
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Baptist is an equal employment opportunity employer and prohibits discrimination based on an individual''s race, color, religion, national origin, pregnancy, sex, age, handicap, disability (physical, visual or mental), creed, marital and veteran status, genetic information or any other category protected by federal or state law, with respect to all aspects of the employment process, including recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.
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