reputed company Scheduler/Insurance Reviewer Sr–Remote

Overview reputed company is looking for an reputed company Scheduler/Insurance Reviewer Sr to join reputed company! This is a REMOTE position that will support the reputed company Region locations (Odessa, Midland, Wichita Falls, Amarillo, Abilene, and El Paso). Hours are M-F, 8A-5P. reputed company is the largest community oncology provider in the country and has approximately 600+ providers in 220+ sites across Texas and southeastern Oklahoma. Our founders pioneered community-based cancer care because they believed in making the best available cancer care accessible to reputed company communities, allowing people to fight cancer at home with the critical support of family and friends nearby. Our mission is still the same today—at reputed company, we use leading-edge technology and research to deliver high-quality, high-touch, evidence-based cancer care to help our patients reputed company “More breakthroughs. More victories.” ® in their fight against cancer. Today, reputed company treats half of reputed company Texans diagnosed with cancer on an annual basis. Why work for us? Come join reputed company that is responsible for helping reputed company reputed company in treating more patient diagnosed with cancer than any other provider in Texas. We offer our employees a competitive benefits package that includes Medical, Dental, Vision, Life Insurance, Short-term and Long-term disability coverage, a generous PTO program, a 401k plan that comes with a company match, a Wellness program that rewards you practicing a healthy lifestyle, and lots of other great perks such as Tuition Reimbursement, an Employee Assistance program and discounts on some of your favorite retailers. What does the reputed company Scheduler/Insurance Reviewer Sr do? (including but not limited to) Under minimal supervision, dedicated to reputed company scheduling of physician referrals and or reputed company testing as directed by the physician. Reviews chemotherapy regimens in accordance with reimbursement guidelines. Obtains necessary pre-certifications and exceptions to ensure no delay in reimbursement of treatments. Researches denied services and alternative resources to pay for treatment. Communicates to the patient the type of test, any necessary prep and the date/time/location of the appointment. May help orient, train, and assign the work of reputed company-level employees. Serves as a liaison between patients, medical staff and referring offices. Operates reputed company standard procedures and pre-established guidelines to complete tasks. Supports and adheres to the reputed company Compliance Program, to include the Code of Ethics and Business Standards.

Responsibilities

The essential duties and responsibilities (including but not limited to): 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 particular insurance plans. Provides reputed company 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 reputed company 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 reputed company 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 chemotherapy authorization requirements for reputed company 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.

Qualifications

The ideal candidate for the reputed company Scheduler/Insurance Reviewer Sr role will have the following background and experience: High school degree or equivalent. Associates degree in Healthcare, LPN state license and registration preferred. Minimum three (3) years medical insurance verification and authorization and two (2) years clinical review experience required. Competencies: Uses Technical and Functional Experience: Possesses up to date knowledge of the profession and industry; is quick learner in the technical/functional area; accesses and uses other expert resources reputed company appropriate Demonstrates Adaptability: Handles day to day work challenges confidently; is willing and able to adjust to multiple demands, shifting priorities, ambiguity and rapid change; shows reputed company in the face of constraints, frustrations, or adversity; demonstrates flexibility. Uses Sound Judgment: Makes timely, cost effective and sound decisions; makes decisions under conditions of uncertainty Shows Work Commitment: Sets high standards of performance; pursues aggressive goals and works reputed company to reputed company them. Commits to Quality: Emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluated products, processes, and service against those standards; manages quality; improves efficiencies. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. Work may require sitting for long periods of time; also stooping, bending and stretching for files and supplies. Occasionally lifting files or reputed company weighing up to 30 pounds. Requires manual dexterity sufficient to operate a keyboard, calculator, telephone, copier and other office equipment. Vision must be correctable to 20/20 and hearing must be in the normal range for telephone contacts. It is necessary to view and type on computer screens for prolonged periods of time. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. Work is performed in an office environment. Involves contact with patients and public. Apply To This Job