ATLANTICAREROLE DESCRIPTIONPOSITION SUMMARYThe Oncology Authorization Navigator is responsible for coordinating and facilitating insurance verification, prior authorizations, and financial navigation processes for oncology patients at the Cancer Care Institute locations in Egg Harbor Township and Cape May Court House. This role supports both Radiation Oncology and Medical Oncology services, ensuring accurate and timely completion of access and billing functions critical to patient care and revenue cycle operations.This role plays a vital part in the patient access process by overseeing all pre-certifications, authorizations, and financial clearance activities. The team is structured into two specialized focus areas, one dedicated to prior authorizations and another to financial clearance and collections. In performing these functions, the Oncology Insurance and Authorization Navigator works closely with Financial Navigators to ensure a seamless financial experience for patients, particularly those facing complex treatment plans or financial hardship.The Oncology Navigator must possess a comprehensive working knowledge of all insurance payers, including commercial, Medicare, Medicaid, and government programs. This role is responsible for ensuring accurate insurance clearance, coordinating benefits across multiple payers, and verifying coverage details to prevent claim denials or delays. The Navigator ensures the accuracy of patient registration, confirming insurance information and eligibility prior to service. The role functions independently within established departmental protocols and expectations, while maintaining a high standard of accuracy and compliance. Additionally, the Navigator is expected to attend all required training courses, in-services, and successfully complete competency assessments to ensure continued proficiency in the role.Key responsibilities include working with third-party payers and their designated portals to obtain required authorizations for a wide range of oncology services, including but not limited to treatments, imaging, laboratory studies, procedures, medications, and supportive care interventions. The Navigator also facilitates physician-to-physician peer reviews for cases requiring additional clinical documentation or justification. In addition, the Navigator ensures the accurate assignment of ICD-10 and CPT codes, collects statistical and financial data, reconciles charge information, and ensures timely processing of all oncology-related accounts.The Oncology Navigator acts as a liaison between the oncology team, Patient Access, Financial Navigators, and other departments to promote continuity of care and maximize revenue cycle outcomes. This role also plays an integral part in assisting with insurance appeals and resolving denials to ensure timely and accurate reimbursement. The Navigator ensures patient accounts are complete, accurate, and ready for billing, and supports communication and coordination between clinical and administrative staff to prevent treatment delays.Additional responsibilities and duties may be assigned as required to support patient financial support services or other areas of the department.KEY RESPONSIBILITIES:Coordinate and facilitate insurance verification, prior authorizations, and financial navigation processes for oncology patients, supporting both Radiation and Medical Oncology services.Oversee pre-certifications, authorizations, and financial clearance activities, ensuring accurate and timely completion for patient care and revenue cycle operations.Work closely with Financial Navigators to provide seamless financial navigation, particularly for patients with complex treatment plans or financial challenges.Possess comprehensive knowledge of all insurance payers (commercial, Medicare, Medicaid, and government programs) and ensure accurate insurance clearance and coordination of benefits across multiple payers.Verify insurance coverage and eligibility prior to service to prevent claim denials or delays.Ensure the accurate assignment of ICD-10 and CPT codes for oncology services, including treatments, imaging, laboratory studies, medications, procedures, and supportive care.Facilitate physician-to-physician peer reviews for cases requiring additional clinical documentation or justification.Reconcile charge data and ensure timely processing of oncology-related accounts.Act as a liaison between the oncology team, Patient Access, Financial Navigators, and other departments to promote continuity of care and optimize revenue cycle outcomes.Assist with insurance appeals and resolve denials to ensure timely reimbursement and accurate claims processing.Ensure patient accounts are complete, accurate, and ready for billing, coordinating communication between clinical and administrative staff to avoid treatment delays.Attend all required training sessions and in-services to maintain proficiency in job duties and departmental procedures.Perform additional duties related to patient financial support services or other departmental areas as needed.PERFORMANCE EXPECTATIONSDemonstrates the competencies as established on the Assessment and Evaluation Tool for this position.WORK ENVIRONMENTPotential for exposure to the hazards and risk of the hospital environment, including exposure to infectious disease, hazardous substances, and potential injury. This position requires reaching, stooping, kneeling, and crouching approximately 25% of the workday. This position also requires frequent lifting, approximately 25-30 pounds, and occasional lifting of 50-100 pounds with assistance.REPORTING RELATIONSHIPThis position reports to the Oncology Practice Manager.

Benefits offerings may vary based on position and are subject to eligibility requirements.
Join a team that values your well-being and invests in your future.