Baptist Memorial Health Care
Specialist-Authorization Denial
– Baptist Memorial Health Care, Memphis, TN
Summary
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 and prior authorizations per payer guidelines, performs insurance verification, 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 revenue. Performs other duties as assigned.
Overview
Summary repeated content: (Same as above).
Job Responsibilities
Obtain and review treatment/therapy plan orders for medical necessity and appropriateness according to insurance medical policy/FDA/NCCN guidelines and requirements.
Research insurance company medical policies, medical literature, and compendiums to determine eligibility for services.
Utilize multiple healthcare websites.
Track, obtain, and extend authorizations from various carriers in a timely manner.
Complete the insurance verification process.
Work closely with physicians and clinic staff to obtain authorizations, promoting positive patient outcomes and reimbursement.
Understand and comply with regulatory requirements by specific insurance companies and facilitate compliance through communication and documentation to appropriate staff.
Review, assess, and evaluate all authorization denial communications received to optimize reimbursement.
Requirements, Preferences & Experience
Education
– Preferred: Associate’s degree or 2 years of college‑level coursework. Minimum: Communication skills in standard English, legible writing, accurate record‑keeping.
Experience
– Preferred: 5 years of business experience in a healthcare environment with at least 3 years payer‑specific experience. Minimum: 3 years clinical experience in a clinical care setting; pre‑certification experience desired.
Special Skills
Strong organizational, critical thinking, and judgement skills.
Excellent customer service and communication skills.
Ability to read and understand medical policies, compendiums, LCDs, and FDA guidelines.
Multitasking, flexibility, and ability to handle confrontational issues and high stress situations.
Advanced computer literacy and problem‑solving skills.
Knowledge of oncology pre‑certification requirements and guidelines.
Required ability to appropriately use standard criteria established by payers.
Licensure, Registration, Certification
Preferred: Pharmacy Tech, CHAA, RHIT, LPN, RN.
About Baptist Memorial Health Care
At Baptist, we owe our success to our colleagues, who possess technical expertise and a compassionate attitude. We reward their efforts with competitive compensation and benefits. For two consecutive years, Baptist has won a Best in Benefits award, offering the best benefit plans compared to peers.
At Baptist, We Offer
Competitive salaries
Paid vacation/time off
Continuing education opportunities
Generous retirement plan
Health insurance, including dental and vision
Sick leave
Service awards
Free parking
Short‑term disability
Life insurance
Health‑care and dependent‑care spending accounts
Education assistance/continuing education
Employee referral program
Seniority Level : Mid‑Senior Level
Employment Type : Other
Job Function : Other
Industries : Hospitals and Health Care
Job Type : Full Time
Work Schedule : Days
Location : US: Memphis, TN
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– Baptist Memorial Health Care, Memphis, TN
Summary
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 and prior authorizations per payer guidelines, performs insurance verification, 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 revenue. Performs other duties as assigned.
Overview
Summary repeated content: (Same as above).
Job Responsibilities
Obtain and review treatment/therapy plan orders for medical necessity and appropriateness according to insurance medical policy/FDA/NCCN guidelines and requirements.
Research insurance company medical policies, medical literature, and compendiums to determine eligibility for services.
Utilize multiple healthcare websites.
Track, obtain, and extend authorizations from various carriers in a timely manner.
Complete the insurance verification process.
Work closely with physicians and clinic staff to obtain authorizations, promoting positive patient outcomes and reimbursement.
Understand and comply with regulatory requirements by specific insurance companies and facilitate compliance through communication and documentation to appropriate staff.
Review, assess, and evaluate all authorization denial communications received to optimize reimbursement.
Requirements, Preferences & Experience
Education
– Preferred: Associate’s degree or 2 years of college‑level coursework. Minimum: Communication skills in standard English, legible writing, accurate record‑keeping.
Experience
– Preferred: 5 years of business experience in a healthcare environment with at least 3 years payer‑specific experience. Minimum: 3 years clinical experience in a clinical care setting; pre‑certification experience desired.
Special Skills
Strong organizational, critical thinking, and judgement skills.
Excellent customer service and communication skills.
Ability to read and understand medical policies, compendiums, LCDs, and FDA guidelines.
Multitasking, flexibility, and ability to handle confrontational issues and high stress situations.
Advanced computer literacy and problem‑solving skills.
Knowledge of oncology pre‑certification requirements and guidelines.
Required ability to appropriately use standard criteria established by payers.
Licensure, Registration, Certification
Preferred: Pharmacy Tech, CHAA, RHIT, LPN, RN.
About Baptist Memorial Health Care
At Baptist, we owe our success to our colleagues, who possess technical expertise and a compassionate attitude. We reward their efforts with competitive compensation and benefits. For two consecutive years, Baptist has won a Best in Benefits award, offering the best benefit plans compared to peers.
At Baptist, We Offer
Competitive salaries
Paid vacation/time off
Continuing education opportunities
Generous retirement plan
Health insurance, including dental and vision
Sick leave
Service awards
Free parking
Short‑term disability
Life insurance
Health‑care and dependent‑care spending accounts
Education assistance/continuing education
Employee referral program
Seniority Level : Mid‑Senior Level
Employment Type : Other
Job Function : Other
Industries : Hospitals and Health Care
Job Type : Full Time
Work Schedule : Days
Location : US: Memphis, TN
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