Referral / Insurance Authorization Specialist.
$20/hour depending on experience and qualifications,
High school degree or equivalent.
Experience with Radiology and Oncology Required.
Associates Degree in Healthcare, LPN state license and registration preferred.
Minimum three (3) years medical insurance verification and authorization and two (2) years clinical review experience required.
The essential duties and responsibilities (including but not limited to)
- Reviews, processes, and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence.
- Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans. Provides prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered chemotherapy drugs.
- Updates coding/payer guidelines for clinical staff. Tracks pathways and performs various other business office functions on an as needed basis.
- Obtains insurance authorization and pre-certification specifically for chemotherapy services. Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
- Researches additional or alternative resources for non-covered chemotherapy services to prevent payment denials. Provides a contact list for patient community resources including special programs, drugs and pharmaceutical supplies and financial resources.
- Maintains a good working knowledge of chemotherapy
authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization. Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patient*s records.
- Other duties as requested or assigned.
Job Type: Full-time
Pay: From $20.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Weekly day range:
Experience:
- Insurance verification: 4 years (Required)
- Clinical Review: 4 years (Required)
Work Location: In person