Clinical Insurance Reviewer
Company: Regional Business Office
Location: Norfolk
Posted on: January 22, 2023
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Job Description:
Overview:
Employment Type: Full TimeIn-Office PositionBenefits: M/D/V, Life
Ins., 401(k)Norfolk, Virginia -JOB SCOPE: -Under general
supervision, reviews chemotherapy regimens in accordance to
reimbursement guidelines. Obtains necessary pre-certifications and
exceptions to ensure no delay in reimbursement of treatments.
Research denied services and alternative resources to pay for
treatment. Supports and adheres to the US Oncology Compliance
Program, to include the Code of Ethics and Business Standards. -The
US Oncology Network is a thriving organization that fosters
forward-thinking, advancement opportunities, and an inspired work
environment. We continuously look for top talent who will continue
to propel our organization in the right direction and celebrate new
successes! Come join our team in the fight against cancer!About US
OncologyThe US Oncology Network is one of the nation's largest
networks of community-based oncology physicians dedicated to
advancing cancer care in America. The US Oncology Network is
supported by McKesson Corporation focused on empowering a vibrant
and sustainable community patient care delivery system to advance
the science, technology, and quality of care. For more information,
visit -www.usoncology.com. We extend an extremely competitive
offering of benefits to employees, including Medical Health Care,
Dental Care, Vision Plan, 401-K with a matching component, Life
Insurance, Short-term and Long-term disability, and Wellness &
Perks Programs.
Responsibilities:
ESSENTIAL DUTIES AND RESPONSIBILITIES: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
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. Research additional or
alternative resources for non-covered chemotherapy services to
prevent payment denials. Provides a contact list for patient's
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.
Qualifications:
- -Minimum Qualifications:High school degree or equivalent.
Associates degree in Healthcare.Minimum three (3) years medical
insurance verification and authorization required.
Keywords: Regional Business Office, Norfolk , Clinical Insurance Reviewer, Healthcare , Norfolk, Virginia
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