Insurance Reviewer

US Oncology Network-posted 4 months ago
Full-time • Entry Level
Wichita, KS
Ambulatory Health Care Services
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The Cancer Center of Kansas (CCK) is seeking a full-time, on-site Insurance Reviewer to join our team in our Wichita, KS offices. The typical work week is Monday through Friday, 8:30 AM - 5:00 PM with no major holidays, no on-call and no weekends. As part of The US Oncology Network and with over 40 years being established in Kansas, CCK delivers quality, personalized cancer care to communities across the state. Our physicians and staff treat patients in over 18 locations throughout the state. Our management and physician teams continue to be recognized in our communities for Excellence in Healthcare! With our mission in mind, we value each and every employee for their life-saving expertise and the role they play in making our patients' lives as easy and comfortable as possible. Our employees are our most valuable resource. They help us create and continue to deliver on our mission. In CCK's partnership with the US Oncology Network, one of the nation's largest networks of community-based oncology physicians dedicated to advancing cancer care in America and supported by McKesson Corporation, we are able to extend an extremely competitive offering of benefits to employees.

  • Obtains prior authorization for scans, labs, subsequent chemotherapy visits or any other service as required.
  • Maintains a professional working relationship with co-workers, insurance companies and referring doctor offices.
  • Assists in receiving and reviewing orders from CCK providers to analyze if necessary to, and then when necessary, obtain prior-authorization.
  • Receives and reviews clinical documents within the electronic medical record (EMR) in order to meet requirements for obtaining the authorization.
  • Services responsible for obtaining prior authorizations for may include radiology, laboratory, chemotherapy and injections.
  • Contacts referring physicians and facilities to obtain referrals for all services scheduled at CCK.
  • Provides clinical information to insurance companies and case managers as needed.
  • Coordinates peer to peer calls between physicians and insurance companies.
  • Assists in maintaining up to date information on insurance requirements for all authorization needs per payer.
  • Uploads and attaches authorizations and referrals to the practice management system (PMS) and EMR as needed.
  • Contacts insurance companies through effectively navigating company websites, managed care portals and through methods such as phone and fax in order to complete prior authorization information requests for ordered services.
  • Timely and accurate entry of information in the PMS and EMR.
  • Follows the status of authorizations and referrals to ensure timely receipt.
  • Ability to multi-task and communicate through various mediums.
  • Maintains a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization.
  • Remains current on all compliance requirements and in part, demonstrates knowledge of Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patient's records and information.
  • Attends required, applicable meetings.
  • Ensures all applicable policies and procedures of the company and Network are followed.
  • Performs other tasks as reasonably requested by a provider or member of the Management Team, as applicable to the role.
  • High school degree or equivalent.
  • Associates degree in Healthcare or Business-related preferred.
  • Minimum three (3) years medical insurance verification and authorization required.
  • Medical Health Care
  • Dental Care
  • Vision Plan
  • 401-K with a matching component
  • Life Insurance
  • Short-term and Long-term disability
  • FSA and HSA
  • Legal Insurance
  • Competitive Paid Time Off Plan
  • Wellness & Perks Programs
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