Insurance Review - Clinical

The US Oncology Network•Wichita, KS

18h•Onsite

About The Position

The Cancer Center of Kansas (CCK) is seeking a full-time, on-site Insurance Reviewer for its Wichita, Kansas offices. The role works under general supervision to review chemotherapy regimens and orders for compliance with reimbursement guidelines and standards of care, and to obtain required pre-certifications and exceptions so treatment reimbursement is not delayed. The position supports the US Oncology Compliance Program, including its Code of Ethics and Business Standards. The Insurance Reviewer processes authorization and referral needs for services such as radiology, laboratory tests, chemotherapy, injections, scans, and subsequent chemotherapy visits. The role reviews provider orders and clinical documents in the electronic medical record, communicates with insurers, case managers, referring physicians, and facilities, coordinates peer-to-peer calls, and records authorizations in the practice management system and EMR. The position requires current knowledge of payer authorization requirements, applicable coverage guidelines, and confidentiality and compliance requirements. The typical schedule is Monday through Friday, 8:30 AM to 5:00 PM, with no major holidays, on-call duties, or weekends. The work is performed on site and may include minimal automobile travel to office sites. The clinic environment may involve exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other conditions common to oncology/hematology settings. Physical demands include sitting or standing, talking and hearing, extensive standing and walking, full-range body motion, patient handling and lifting, manual and finger dexterity, eye-hand coordination, and occasionally lifting or carrying items up to 40 pounds. Reasonable accommodations may be made for individuals with disabilities.

Requirements

High school degree or equivalent.
At least three years of medical insurance verification and authorization experience.
Current knowledge of chemotherapy authorization requirements, payer requirements, and state and federal coverage and authorization guidelines.
Ability to handle competing demands, shifting priorities, ambiguity, and change.
Sound judgment and timely decision-making, including under uncertainty.
Commitment to high performance standards, quality, efficiency, and achieving goals.
Ability to work effectively with others and contribute to a positive, productive team environment.
Ability to follow confidentiality and compliance requirements, including HIPAA.
Ability to meet the position's physical demands, with reasonable accommodations where applicable.

Nice To Haves

Associate degree in healthcare or a business-related field.

Responsibilities

Obtain prior authorization for scans, laboratory tests, subsequent chemotherapy visits, and other services as required.
Maintain professional working relationships with coworkers, insurance companies, and referring physician offices.
Receive and review orders from CCK providers, determine whether authorization is needed, and obtain it when necessary.
Review clinical documents in the EMR to meet authorization requirements.
Obtain prior authorizations for radiology, laboratory, chemotherapy, injections, and other applicable services.
Contact referring physicians and facilities to obtain referrals for services scheduled at CCK.
Provide clinical information to insurance companies and case managers as needed.
Coordinate peer-to-peer calls between physicians and insurance companies.
Help maintain current information about payer-specific insurance requirements for authorizations.
Upload and attach authorizations and referrals to the practice management system and EMR as needed.
Contact insurance companies through websites, managed care portals, phone, and fax to complete prior-authorization information requests.
Enter information accurately and promptly in the practice management system and EMR.
Monitor authorization and referral status to ensure timely receipt.
Multi-task and communicate through various mediums.
Maintain working knowledge of chemotherapy authorization requirements across payers and of state and federal coverage and authorization guidelines.
Remain current on compliance requirements and follow confidentiality, state, federal, and HIPAA requirements for patient records and information.
Attend required applicable meetings and follow company and Network policies and procedures.
Provide departmental coverage and perform other duties reasonably requested or assigned, including by a provider or member of the Management Team.