2 jobs found in Sodus

Onco360 is seeking a Compliance Auditor to support our growing regulatory programs nationwide. The role involves on-site audits at Onco360/CareMed/ConnectMed360 locations, as well as remote and desktop reviews to ensure operations meet state and federal pharmacy regulations. Travel up to 25% is required, and the starting salary is $60,000 and up, depending on experience. This position supports the Compliance Team and reports to the Vice President, Specialty Pharmacy Compliance. #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....