Prior Authorization Specialist/Clinical Insurance Reviewer - Remote ( Southern Nevada only)
The US Oncology Network•Henderson, NV
•Remote
About The Position
Comprehensive Cancer Centers of Nevada (CCCN) is seeking a Clinical Insurance Reviewer to work remotely in the Southern Nevada area only. The Clinical Reviewer reviews diagnostic imaging and pulmonary testing orders in accordance to reimbursement guidelines and obtains necessary pre-certifications and exceptions to ensure no delay in reimbursement of treatments. This role involves reviewing chemotherapy regimens, obtaining pre-certifications and exceptions, researching denied services and alternative resources, and supporting the US Oncology Compliance Program.
Requirements
- High school diploma or equivalent required
- Minimum three (3) years medical insurance verification and authorization required
Nice To Haves
- Associates degree in Healthcare
- LPN state license and registration preferred
Responsibilities
- Reviews, processes and audits the medical necessity for each patient radiation oncology treatment, imaging and testing requests
- 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 documentation issues and payer issues with non-covered or denied services
- Updates coding/payer guidelines for clinical staff
- Obtains insurance authorization and pre-certification for imaging, pulmonology and surgical 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 patients community resources including special programs, drugs and pharmaceutical supplies and financial resources.
- Maintains a good working knowledge of 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
Benefits
- excellent benefits
- professional development
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
