Start
Medical Precertification Specialist
San Antonio, TX
Sponsorship not specifiedDetected 30 days ago
ComplianceProcess ImprovementHIPAAEHR/EMRICD-10CommunicationCollaborationProblem SolvingMicrosoft Office
About the role
- Job Description: Medical Precertification Specialist - LVN plays a vital role in ensuring timely and accurate authorization of medical services, medications, and treatments, particularly within the oncology field.
Responsibilities
- Manage the authorization process for high-cost medications, chemotherapy regimens, and supportive treatments.
- Utilize knowledge of oncology medications and treatment protocols to support clinical review processes.
- Collaborate with oncology care teams to ensure continuity of care and timely initiation of treatment.
- Maintain compliance with HIPAA and other regulatory standards.
- Partner with the oncology care team, pharmacy, billing, and scheduling departments to ensure seamless coordination of care.
Requirements
- Licensure
- Active and unrestricted LVN license
- Experience
- Minimum 1-2 years of clinical experience in a healthcare setting.
- Preferred:
- Knowledge
- Strong understanding of medical terminology, oncology-specific treatments, and coding (CPT, ICD-10).
Nice to have
- Previous experience with medication authorization, particularly for oncology treatments.
- Familiarity with oncology treatment protocols and medications, including chemotherapy, immunotherapy, and supportive medications.
- Comprehensive knowledge of insurance requirements for oncology medications and procedures.
Skills
- Excellent analytical and problem-solving skills.
- Proficiency in electronic medical records (EMR) systems and Microsoft Office Suite.
- Strong interpersonal and communication skills, with the ability to explain complex information to patients and providers.
- Key Competencies
- Exceptional attention to detail, particularly in clinical and administrative tasks.
- Empathy and professionalism when dealing with patients undergoing cancer treatment.
- Commitment to continuous learning and staying updated on oncology advances and payer policies.
Benefits
- We offer competitive wages, benefits, and yearly bonus opportunities.
- Evaluate requests for medical services, medications, and treatments, with a focus on oncology therapies, to ensure compliance with clinical guidelines and insurance requirements.
- Liaise with insurance companies to secure prior authorizations and resolve coverage issues.
- Analyze clinical records and treatment plans to determine medical necessity and appropriateness of care.
- Ensure all approvals, denials, and related details are accurately documented in the electronic medical record (EMR) system.
- Serve as the primary point of contact between healthcare providers, insurance carriers, and patients for authorization-related matters.
- Provide clear and compassionate communication to patients regarding insurance coverage and authorization status.
- Monitor changes in medication coverage policies, particularly for oncology drugs and supportive care products.
Company info
- We are pioneering premier Cancer Care for our patients with leading doctors, advanced diagnostics and cutting-edge therapies.
This listing is sourced directly from Start's careers page and normalized into a canonical job model.