Pathology Tertiary Authorization Coordinator

Founded in 2007, The Oncology Institute of Hope and Innovation (TOI) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. TOI is dedicated to offering cutting edge, evidence-based cancer care to a population of more than 1.7 million patients including clinical trials, stem cell transplants, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With 100+ employed clinicians and more than 800 teammates in 60+ clinic locations and growing. TOI is changing oncology for the better.

JOB PURPOSE AND SUMMARY:

The Pathology and Tertiary Coordinator is responsible for processing all pathology, genetic testing, and tertiary appointments within a reasonable timeframe. This position is responsible for coordinating with insurance carriers, clinical staff, patients, and external laboratories to effectively process authorization requests for Tertiary, Pathology, and Genetic testing. Additionally, this role compiles clinical documentation for prior authorization requests for coverage and communicates with patients, medical doctors, and external labs for financial assistance and/or coverage.

ESSENTIAL DUTIES AND RESPONSBILITIES:

• Review and process pathology and tertiary authorization requests via portal, phone, and/or paper.

• Compile relevant information to overturn genetic denials and appeals, as needed.

• Process requests and complete paperwork for additional testing as requested by ordering physicians.

• Process requests, complete paperwork, and send to holding facilities for pathology testing.

• Adhere to protocols for molecular testing per insurance requirements and internal guidelines.

• Maintain timely and accurate documentation within tracking system.

• Provide timely follow up and communication with physicians, clinical staff, and external labs.

• Utilize external laboratory test menus to enter specimen collection information.

• Review and process laboratory requisition submissions via online and/or paper req.

• Coordinate block procurements between lab and holding facilities.

• Coordinate specimen returns to holding facilities, as needed.

• Ensure accuracy of specimen collection and instructions, stability, alternative specimens

• Schedule higher level of care appointments with corresponding specialist.

• Schedule clinical trial evaluations for possible enrollment with higher level of care facilities.

• Manage incoming communications from patients, physicians, eternal laboratories, and clinical staff.

• Utilize website portal and electronic options to submit authorization requests.

• Cross-train in other job duties as time allows and as coordinated with management.

• Perform additional projects as needed, such as assisting with other duties as requested by supervisor, manager, or administrator.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Detail-oriented, organized, and a team player.

• Proficient with computer systems, technology, and standard office equipment.

• Proficient in Microsoft Office, Word, Adobe, and Excel.

• Knowledge of medical concepts/terminology is preferred.

• Knowledge of insurance company's procedures and policies.

• Knowledge of dual risk insurances such as HMO, PPO, Medicare, Medi-Cal, and Tricare

• Knowledge of CPT codes, diagnosis codes, and test codes.

• Knowledge of pathology testing and genetic testing.

• Ability to utilize computer-based portals, tracking systems, EMR, and scheduling tools.

• Ability to take initiative, maintain attention to detail, and prioritize workload.

• Excellent written/verbal communication and interpersonal skills.

• Strong customer service skills with a commitment to accuracy, detail, and HIPPA confidentiality.

• Strong time management, multi-tasking, and organization skills

REQUIRED EXPERIENCE, EDUCATION AND/OR TRAINING:

• High School Diploma, GED, or equivalent.

• Minimum one year of related authorization and/or laboratory experience.

• Medical Assistant or Medical Lab experience is preferred.

• Hematology and Oncology experience strongly preferred.

• Bilingual preferred.

PHYSICAL WORKING REQUIREMENTS:

The position involves prolonged periods of sitting at a desk, extensive computer use, and phone interaction. Additionally, the role may require occasional lifting of up to 20 pounds for office supplies or equipment.

The physical demands described above are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role.

Pay Transparency for hourly teammates

$18-$21 USD