Prior Authorization Representative Radiation Oncology

Banner Health

1d•Onsite

About The Position

Join our Radiation Oncology team as a Prior Authorization Representative, where you'll play a vital role in ensuring seamless, compassionate care for patients throughout their treatment journey. In this position, you'll be the essential link between patients, families, and our clinical care team, managing everything from insurance authorization and verification to appointment scheduling and documentation. Your primary focus will be processing authorization requests for Radiation Oncology treatments, ensuring patients can access the care they need without administrative delays. You'll conduct personalized patient needs assessments, connect patients with valuable resources, and provide ongoing support across the entire healthcare continuum. This role offers the opportunity to make a meaningful difference in patients' lives by removing barriers to care and creating a positive, stress-free experience during a challenging time. You'll also gain cross-training in front desk operations and inbound call management, expanding your skill set while maintaining your core focus on authorization coordination. If you're detail-oriented, compassionate, and thrive in a collaborative healthcare environment, this is your chance to contribute to exceptional patient care in Radiation Oncology.

Requirements

High school diploma/GED or equivalent working knowledge.
Requires skills and abilities typically attained with three or more years working in a hospital or medical office.
Requires knowledge of medical terminology.
Must be able to work under minimal supervision and make independent decisions using good judgment.
Excellent communication, human relations, attention to detail and organizational skills are required.
Must possess highly developed interpersonal relations and process coordination skills.
Roles supporting mobile medical unit require travel within local community.
Requires knowledge of payer contract terms and processes.
Requires the ability to perform basic math function and the ability to handle confidential information and sensitive issues.
Must be able to work effectively with common office software and hospital software to perform intake and updates to patient medical history in addition to other software used in scheduling and billing.
Employees working at Banner Behavioral Health Hospital, BTMC Behavioral, and BUMG, BUMCT, or BUMCS in a Behavioral Health clinical setting that serves children must possess an Arizona Fingerprint Clearance Card at the time of hire and maintain the card for the duration of their employment.
An Arizona Criminal History Affidavit must be signed upon hire.

Nice To Haves

Additional related education and/or experience preferred

Responsibilities

Performs patient intake process, which may include pre-registration/registration.
Partners with the clinical care team to determine initial authorizations needed based on the predicted care treatment plan.
Obtains patient insurance benefit information for all aspects of the treatment, including, but not limited to, inpatient and outpatient services, prescription drugs, and travel and housing, if necessary.
May also answer questions regarding the authorization process and supply information to providers, patients and third party payors.
Acts as a resource for insurance coverage, which may include obtaining authorizations and notifications throughout the patient’s treatment.
Obtains all necessary signatures and documentation required by the patient’s insurance plan.
Accurately and completely documents all information into the patient records system to ensure maximum reimbursement.
Monitors and updates information regarding insurance data, authorizations, preferred providers and changes in patient’s treatment plan.
Partners with the clinical care team and insurance provider to ensure continued coverage of patient’s care and maximum reimbursement and minimized financial impact to the patient.
Provides administrative support in maintaining materials such as documents, proposals, routine correspondence, spreadsheets, composing and preparing routine reports, and maintaining records in a variety of business software and database applications for electronic medical records, billing, data management.
Schedules physician appointments, tests, procedures and surgeries and may provide patient with necessary preparation instructions.
Prepares, processes, and manages patient documentation to department database .
Acts as a liaison between the patient, billing department, and payor to enhance account receivables, resolve outstanding issues and/or patient concerns.
Optimizes patient experience by using effective customer service.
Communicates continually with patients, other departments, referral networks and providers to ensure appropriate plans and protocols are followed.
Uses discretion and is attentive to issues of customer confidentiality.
Demonstrates skills in pro-active resolution and attempts to resolve scheduling conflicts.
May manage the medical record for the assigned area, including coordination with hospitals, practice offices and other ancillary services to obtain needed records.
Responds to patient referral requests for tests, procedures and specialty visits.
Follows guidelines and may assist in developing procedures to ensure that medical records are in compliance with all state and federal laws.
May also reconcile charge tickets, identifying incomplete tickets, missing charge codes or missing diagnosis codes.
Notifies clinical staff as needed.
Works independently under general supervision, following established procedures.
Uses knowledge and problem-solving skills to work independently in a clinic/physician practice environment.
Responsibility for ensuring efficient coordination of administrative functions supporting patient needs assessments, insurance and authorization verification, registration, maintaining and handling of documentation, financial counseling, and scheduling of appointments.
Internal and external customers include patients and their families, physician offices, third party payors, vendors, clinical staff, ancillary staff, therapist, nurses and case managers.
Primary responsibility is to main department assigned, however cross-over and assistance to other departments is required.