Key Areas of Responsibility:
Treatment Authorization Management
• Obtain and manage authorizations for infusion therapies, injectable medications, and other in-office treatments.
• Review assigned work queues, schedules, and provider orders to identify authorization requirements.
• Submit complete and accurate authorization requests to payers.
• Monitor authorization status and ensure approvals are secured prior to scheduled treatment whenever possible.
• Coordinate peer-to-peer reviews and additional documentation requests when required by payers.
• Communicate authorization outcomes, delays, denials, and approval information to providers, nursing staff, schedulers, and Financial Counselors.
• Escalate authorization barriers that may impact patient care according to department procedures.
• Assist with appeals and reconsiderations when appropriate.
• Maintain accurate authorization documentation within the electronic medical record.
• Ensure authorizations are obtained within established departmental timelines.
• Prioritize urgent and same-day patient care needs appropriately.
Referral and Outside Service Management
• Obtain authorizations for office visits, referrals, imaging, diagnostic testing, procedures, and other services performed outside of MOASD.
• Verify payer requirements and referral pathways.
• Coordinate with referring providers, outside facilities, and payer representatives to secure approvals.
• Ensure all required clinical documentation is submitted to support authorization requests.
• Monitor pending requests and follow up proactively to prevent delays in patient care.
• Document authorization activity and outcomes in accordance with department standards.
• Communicate authorization status to patients and internal teams as appropriate.
Patient Coordination and Communication
• Serve as a resource for patients regarding authorization requirements and payer processes.
• Communicate professionally and compassionately with patients experiencing treatment or referral delays.
• Support patient access by identifying and escalating barriers to care.
Interdepartmental Collaboration
• Collaborate with providers, nursing, scheduling, financial counseling, revenue cycle, and management teams to facilitate timely patient care.
• Respond to authorization-related inquiries within established departmental timelines.
• Participate in process improvement initiatives designed to improve authorization efficiency and reduce treatment delays.
• Promote positive working relationships across departments and external organizations.
Documentation and Compliance
• Maintain accurate, timely, and complete documentation within OncoEMR and other applicable systems.
• Ensure all authorization records, payer communications, and supporting documentation are appropriately filed.
• Maintain compliance with HIPAA, payer regulations, and organizational policies.
• Identify trends, denials, and workflow concerns and communicate findings to leadership.