Insurance Reviewer - Clinical
About The Position
Willamette Valley Cancer Institute is looking for an Insurance Reviewer to support our patients receiving testing and treatment needed for their diagnosis by navigating insurance portals and obtaining all appropriate authorizations. With a focus on authorizations for infusion drugs, radiation therapy, imaging, genetics and surgeries our Insurance Reviewers pave the way for our patients and treatment team to follow the prescribed treatment pathway. An individual that thrives in a high-volume workspace, with the ability to manage shifting priorities will find success in this role. The general pay scale for this position at WVCI is $22.01-$31.00. The actual hiring rate is dependent on many factors, including but not limited to: prior work experience, education, job/position responsibilities, location, work performance, etc. Employment Type: Full Time Benefits: M/D/V, Life Ins., 401(k) Location: Eugene, OR
Requirements
- High school degree or equivalent.
- Minimum three (3) years of prior authorization experience required. Revenue cycle experience preferred.
Responsibilities
- Reviews, processes and audits the medical necessity for treatments including radiation oncology, gynecologic surgery, genetic lab testing, imaging, and chemotherapy treatment for each patient. Documentation of regimen related to pathway adherence and payer guidelines.
- Communicate with nursing, physician, pharmacists 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 for various oncology & hematology related services.
- 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 HIPAA laws and guidelines with regards to patient’s records.
- Other duties as requested or assigned.
Benefits
- M/D/V
- Life Ins.
- 401(k)
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
