Medical Oncology Pre-Certification Coordinator

Description

Are you interested in making a difference in patient care? Learn about our unique culture of respect, growth, innovation, the best patient care, and how we give back to the community.

At United Urology Group, our employees are at the heart of our mission and have incredible opportunities to impact our patients' lives with their urologic care.

• We foster a culture that thrives on compassion, teamwork, integrity, and diversity, all of which start with our staff!
• We deliver a cohesive approach to urologic care that provides patients with access to experienced specialists, a superb team of healthcare professionals, and the most advanced technology for patient treatments and therapies.
• We offer competitive salaries and a great work/life balance: enjoy your weekends!
• UUG offers outstanding benefits, including tuition reimbursement, health, dental, and vision insurance, corporate discounts, and much more!

United Urology Group is regarded as the leading urology network in the country. Our Affiliates include Chesapeake Urology, Arizona Urology—Phoenix & Scottsdale, Arizona Urology—Tucson, Colorado Urology, and Tennessee Urology.

Position Summary:

The Medical Oncology Pre-Certification Coordinator is responsible for obtaining eligibility, benefits, medical necessity, and authorization when required for scheduled services. They are also required to create an estimate of the patient’s financial responsibility.

Primary Duties & Responsibilities:

• Follows the policy and procedures outlined by management to ensure standardization of processes across all providers.
• Obtains verification of insurance coverage and benefits as well as obtains authorization for scheduled services.
• Validates that medical necessity guidelines have been met based on FDA guidelines, Medicare, Medicaid, and managed care payer policies.
• Responsible for verifying a valid referral is on file or initiates a referral request as needed for the scheduled service.
• Consistently initiates authorizations within the appropriate timeframe defined by management.
• Communicate effectively with Pre-Cert Management, Surgical Posters, Site Managers, and Providers regarding scheduling errors, missing medical necessities, out-of-network issues, or authorization denials.
• Generates a patient estimate of responsibility related to self-pay pricing, deductibles, co-insurance, and copays and forwards to the pre-collections team.
• Coordinates with the funding team as needed to obtain financial assistance when appropriate.
• Documents all necessary information regarding eligibility, benefits, authorization, and financial responsibility in the Practice Management System.
• Scans all referrals into EMR and links the referrals to the appointment in the Practice Management System.
• Stays current on insurance carrier requirements related to procedures, preferred drugs, and authorization requirements.
• Acts as an escalation resource assisting other team members to resolve any challenges in obtaining eligibility, benefits, medical necessity, or authorizations prior to the scheduled service.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the employee for this job. Duties, responsibilities, and activities may change at any time, with or without notice.

Qualifications

Qualifications:

• Minimum High School Diploma or GED required.
• Minimum of two (2) years Pre-Certification, Medical Front Office, or Medical Billing experience.
• Medical Oncology experience is required.  

Knowledge, Competencies & Skills:

• Proficient knowledge of Medical Terminology; ICD-9 and CPT-4 Codes.
• Excellent customer service skills.
• Strong written and verbal communication skills.
• Proficient computer software and database skills.
• Strong attention to detail.
• Ability to multi-task and work in a fast-paced environment.
• Collection background is a plus.

Tech Requirements for the Job:

• High-speed, reliable internet connection to ensure uninterrupted communication and access to necessary systems and tools.
• Quiet and private work environment to maintain the confidentiality of patient information and minimize background noise during calls.
• Proficiency in using remote collaboration tools, such as video conferencing software, instant messaging platforms, and customer relationship management systems.
• Compliance with all security and privacy policies and protocols, including safeguarding patient information and maintaining HIPAA compliance.

Direct Reports:         

• N/A.

Travel:

• Must have the ability & willingness to travel to other sites as necessary within a geographic region.

Physical Requirements for the Job:

• Regularly required to sit and stand for extended periods.
• Involves standing, sitting, walking, bending, stooping, and twisting.
• Requires full range of body motion, including manual and finger dexterity and eye-hand coordination.
• Occasionally lifts and carries items weighing up to 25 lbs.

Equal Opportunity Employer: United Urology Group and its affiliate practices are an equal opportunity employer. We do not discriminate based on race, color, religion, age, sex, national origin, disability, veteran status, or sexual orientation.

The successful candidate(s) for any UUG position will be subject to a pre-employment background check.

Actual compensation offered to candidates is based on work experience, education, skill level, and geographic location. Compensation may vary depending on the state or region in which the position is located, in accordance with applicable laws. Applications for this position are accepted on an ongoing basis until the role is filled. There is no specific application deadline.