Pharmacy Prior Authorization Specialist – Onco360 Pharmacy Buffalo, NY | Full-Time | Starting at $23.00/hr and up Join a mission-driven team making a difference in the lives of cancer patients. Onco360 Pharmacy is seeking a Pharmacy Prior Authorization Specialist to join our dedicated team in Buffalo, NY. This is a full-time position ideal for candidates local to the area. Remote work possible after initial on-site training. Company Benefits - Medical; Dental; Vision - 401k with a match - Paid Time Off and Paid Holidays - Tuition Reimbursement - Quarterly Incentive Bonus - Paid Volunteer Day - Referral Incentive Program - Company Paid Life Insurance; and Short/Long-Term Disability Why Join Us? - A career with purpose: Help patients access life-saving medications. - Supportive culture: We value teamwork, respect, integrity, and passion. - Growth opportunities: We invest in your professional and personal development. What You’ll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests. How You’ll Do This - Manage prior authorization requests and appeals with insurance carriers. - Collaborate with physicians, pharmacists, and other departments. - Ensure HIPAA compliance while handling sensitive patient information. - Maintain accurate documentation of authorization details. - Proactively monitor and renew expiring authorizations. What You Bring Required: - High School Diploma or GED - 1+ years of pharmacy or prior authorization experience - Registration with Board of Pharmacy (as required by state law) - Strong communication, organizational, and customer service skills - Self-motivated, organized, detail-oriented, and adaptable to changing priorities - Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds Preferred: - Associate degree or Certified Pharmacy Technician (PTCB) - 3+ years of experience in pharmacy or prior authorizations - Specialty pharmacy experience Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer. #Company Values: Teamwork, Respect, Integrity, Passion

Prochant is seeking an Infusion Reimbursement Manager to work remotely. The Infusion Reimbursement Manager is responsible for managing the billing and collection function for all payer groups including Medicare / Medicaid. Responsible for escalating billing and/or collection issues. This is a highly collaborative role and the ideal candidate can both manage the day-to-day reimbursement as well as document and train other staff. Essential Duties & Responsibilities - Performs and manages the day-to-day reimbursement activities from delivery to payment process for all payer segments. This includes all aspects of the billing and collection functions as outlined in the individual job descriptions - Monitors cash flow, days sales outstanding (DSO), and bad debt losses for payer segment by business to ensure profitability measures are met and maintained. - Monitors billing requirements and receivables pursuant to contracts with third party payers or government programs. - Ensures compliance with federal, state, and local governments, third party contracts, company policy, and general accounting practices. - Manages and analyzes account summaries of outstanding receivable balances for negotiations or settlements. - Revenue review and profitability reporting for accurate margins on a daily, weekly, monthly basis. - Complete Month end required activities per company deadlines - Reviews/statuses adjustments to claim balances and delinquent account transfers to collection agencies according to company procedures and policies. - Acts as the first point of contact for escalation issues from the service provider regarding unresolved unknown deductions on payments received from payer or failure of payer to comply with contract terms as well as for billing and collections issues/claims. - Provides input regarding procedures, develop strategies and new techniques to eliminate errors, increase to cash flow, reduction in avoidable bad debt loss, including recommended changes to billing practices, forms etc. - Supports broader reimbursement team in the formulation of strategies relating to reimbursement management. - Monitors adjustments to claim balances and delinquent account transfers to collection agencies according to company procedures and policies. - Assist with training or onboarding of new employees - Other duties as assigned

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Denials & Appeals Coordinator is responsible for managing, tracking, and resolving denials and appeals to ensure timely reimbursement. This role requires in-depth knowledge of payer guidelines, systems, and requirements to navigate complex denial cases effectively, assist in issue resolution, and help identify trends that can improve claim outcomes. - Monitors assigned queues and duties across various systems (such as, Artiva, HMS, Hyland, BARRT) to ensure all follow-up dates are current. - Analyzes denials to determine appropriate actions, completes appeals, or routes cases for clinical appeals as needed. - Files and monitors appeals to resolve payer denials, documenting all activity accurately and maintaining logs, account notes, and system records. - Maintains an up-to-date understanding of payer guidelines and requirements related to denials and appeals. - Processes BARRT requests, reviews RAC/Government Audit accounts, and completes necessary rebills and adjustments. - Identifies trends in denials to suggest improvements and reduce future claim issues, providing data for denial and appeal trends as needed. - Performs other duties as assigned. - Maintains regular and reliable attendance. - Complies with all policies and standards. Qualifications - H.S. Diploma or GED required - Associate Degree or higher in Health Information Management preferred - 1-3 years of experience in medical billing, revenue cycle, or claims denials and appeals processing required - Prior experience with revenue cycle processes in a hospital or physician office setting required Requirements - Strong knowledge of payer guidelines, medical billing practices, and appeal processes. - Proficiency in relevant software and claim management systems, such as Artiva, HMS, Hyland, and BARRT. - Excellent analytical skills for reviewing denial trends and suggesting improvements. - Strong verbal and written communication skills to interact with payers and internal departments. - Ability to prioritize tasks effectively and manage time in a fast-paced environment. Licenses and Certifications - Certified Revenue Cycle Specialist (CRCS) - AAHAM preferred

• Reviews medical record documentation to abstract and assign diagnoses, procedures, and modifiers for statistical classification and reimbursement purposes. • Provides feedback regarding documentation and coding issues. • Utilizes software applications and coding references, including electronic, to perform coding related tasks. • Maintains an understanding of and ensures compliance with, all applicable Official Coding Guidelines. • Participates in coder and provider education including documentation improvement efforts for providers. • Interacts with provider, nursing staff and departments as assigned. • Assists in the training and quality assurance of all coding levels. • Completes any required coding training or other assigned coding instruction. • Participates in departmental coding and educational meetings and roundtables. • Manages resources in a conservative, responsible and cost-effective manner. • Ensures confidentiality of patient information by creating and maintaining a secure and trusting environment by not sharing information learned on the job, except when necessary in the performance of the job responsibilities. • Works as a member of a coding team for the successful benefit of the department.