Prior Authorization Coordinator

Wosu Org Corp

Columbus, OH, US
Clinical knowledge for medical necessity denials
Scientific evidence for therapies
Clinical education to payers
Use of clinical knowledge for the management of complex James Cancer Center ambulatory medical necessity denials through the appeals process

Job Summary

  • Use of clinical knowledge for the management of complex James Cancer Center ambulatory medical necessity denials through the appeals process.
  • Providing scientific evidence to support cutting edge therapies, and diagnostic services.
  • Identifying trends, and areas for needed clinical education, to decrease denials where applicable.

Matching Summary

Use of clinical knowledge for the management of complex James Cancer Center ambulatory medical necessity denials through the appeals process.

Skills & Requirements

Must-have

  • clinical knowledge for medical necessity denials
  • scientific evidence for therapies
  • clinical education to payers
  • identifying trends for denials
  • submission of pre-determination requests
  • support to CBO billing area

Nice-to-have

  • foster effective working relationships
  • pursue hospital reimbursement
  • facilitate education for compliance

Key Requirements

  • Associate Degree in Nursing preferred
  • 3 years oncology experience preferred
  • 3 years experience in oncology
  • Experience with Windows, Excel, Access
  • Knowledge of Medicare and commercial insurance reimbursement preferred
  • Strong knowledge of ICD-9-CM, HCPCs, and CPT coding preferred

Work Rights

Not specified

Tailored Resume

Cover Letter