Founded in 2007, The Oncology Institute of Hope and Innovation (TOI) is the largest community oncology practice on the west coast, and the nation’s leading value-based oncology services platform. TOI employs 80 physicians and mid-levels in 45 clinic locations, with over 500 total employees helping to deliver cutting edge, evidence-based cancer care to a population of over 1 million patients. TOI is headquartered in Cerritos, CA, and serves patients throughout California, Arizona, Florida, and Nevada.
TOI brings comprehensive, integrated cancer care into community settings, offering patients modern infusion centers, chemotherapy educational sessions, in-house support groups, dietary and nutritional counselling, in-house pharmacy, financial counseling, comprehensive lab testing, advanced care planning, and end-of-life counseling.
Job Duties for Chemo Authorization Specialist:
Coordinate with third-party insurance, clinical staff, and patients to effectively process prior authorization requests for Chemotherapy (IV and Oral), Hydration, IV injections. Compile clinical documentation for prior authorizations (ex: progress notes, labs, diagnoses codes, previously tried therapies, doctor visits). This is one of the most important roles within the organization that allows our patients to receive timely care and TOI's appropriate reimbursement.
Review authorization queue for applicable orders
Verify and comply with payer contractual authorization requirements
Submit authorization request timely and efficiently, ensuring proper documentation is included for review
Utilize website portal, and electronic options to submit authorization requests
Work with management to identify payer trends or potential issues
Demonstrate exceptional customer service skills in the performance of work assignments and duties
Perform special projects or other duties as assigned
Maintains confidentiality of patient records
Self-motivation and ability to work effectively in an independent environment
Experience on the payer side reviewing chemo authorizations submitted by the provider.
Attention to detail
Ability to learn new things quickly
Experience using EMR systems
Highly proficient in Microsoft Office particularly Excel, Word, and Outlook
Work well under deadlines and time pressures
Results-oriented with a focus on high quality.
High school diploma or GED
Experience performing, reviewing, or generating prior authorizations for procedure or chemotherapy specifically is preferred
Administrative experience in a physician office, clinic, hospital, or health insurance/ payer is a plus