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Specialist - Authorization Denial
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- 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.
- Pre-certification experience desired.
- Knowledge of oncology pre-certification requirements and guidelines.
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