-One of two nurses responsible for Radiation Oncology in Fargo, ND and Watertown, SD prior authorization. Working closely with six Radiation Oncologists.
-One of two nurses doing Oncology Surgical prior authorizations for three surgeons in Fargo.
-One of two nurses working Interventional prior authorizations for Radiation and Medical Oncologist Enterprise.
-Confirm active insurance coverage and check if the specific medical service or procedure requires prior approval.
-Gather relevant medical records, physician notes, lab results, and treatment history to prove medical necessity Assist other staff in prior authorization with this process when required.
-Send the completed package via the insurer's online portal, electronic prior authorization (ePA) system, or fax
-Monitor the status of pending requests with the insurance company to prevent care delays.
-If denied, responsible to review reason for denials, compile missing information, and submit formal appeals or peer to peer discussions.
-Maintain valuable communication with Radiation and Medical Oncology staff and physicians to obtain timely prior authorization for each patient.