2 jobs found in Kensington

Onco360 Oncology Pharmacy is seeking a Compliance Auditor to join our growing team in a remote-capable role with travel. The Auditor will support the Compliance Team by performing routine and random audits at pharmacy locations to ensure compliance with state and federal laws. Ideal candidates have a Certified Pharmacy Technician registration and at least two years in pharmaceutical regulatory auditing, plus strong communication, data entry, and project-management skills. #J-18808-Ljbffr

Position Summary The Out-of-Network Authorization Specialist is responsible for securing prior authorizations and verifying benefits for services rendered by providers who are not contracted with a patient’s insurance plan. This role requires strong communication skills, attention to detail, and a deep understanding of payer policies to ensure accurate billing and minimize claim denials. Key Responsibilities Initiate and follow up on prior authorization requests for out-of-network services. Verify patient insurance benefits and eligibility for out-of-network coverage. Communicate with insurance companies to determine coverage levels, out-of-pocket costs, and authorization requirements. Track and document authorization status in the EMR and billing systems. Work closely with billing and collections teams to resolve denied claims and appeals. Stay current with payer-specific guidelines and regulatory changes affecting out-of-network billing. Team player and accuracy are key....