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Cancer Care Workflow Manager
2 weeks ago
About our work
Cancer patients face not just a disease, but a broken healthcare system where delays in treatment are common due to outdated, error-prone workflows.
We aim to streamline oncology care through cutting-edge technology and empower healthcare teams and patients alike.
We are seeking a detail-oriented Oncology Prior Authorization Specialist to manage and streamline the prior authorization process for oncology treatments and procedures.
In this role, you will ensure timely and accurate approvals while maintaining compliance with insurance guidelines.
You will collaborate with oncologists, nursing staff, billing teams, and insurance payers to facilitate access to necessary oncology care and remove barriers to treatment.
- Prior Authorization Process Management: Oversee the entire prior authorization process for oncology treatments, procedures, and medications, ensuring timely and efficient approvals
- Request Review: Evaluate prior authorization requests to confirm they meet medical necessity criteria and payer guidelines
- Care Team Collaboration: Work closely with oncologists, nursing staff, and billing teams to gather necessary clinical documentation and ensure it is submitted accurately and promptly
- Insurance Coordination: Coordinate with insurance companies to resolve coverage issues, denials, and appeals, ensuring that patients receive the care they need without unnecessary delays
- Record Keeping: Maintain accurate records of all prior authorization requests, including approvals, denials, and appeals, ensuring documentation is compliant and well-organized
- Proactive Problem Resolution: Identify and address barriers to timely approvals, proactively addressing payer-specific requirements and facilitating smoother workflows
- Policy & Guideline Updates: Stay informed on insurance policy changes, payer guidelines, and new oncology treatments to ensure compliance and accurate processing of requests
- Feedback & Insights: Support oncology care teams by offering feedback to improve the prior authorization workflow and streamline operational efficiency
- Process Optimization: Utilize electronic medical records (EMR) systems and prior authorization platforms to manage and streamline processes
- Regulatory Compliance: Ensure all communications and documentation comply with regulatory standards