Prior Authorization Specialist/Clinical Insurance Reviewer - Remote ( Southern Nevada only)

Overview

At reputed company (CCCN) a distinguished team of doctors, researchers, nurses and reputed company have provided patients with groundbreaking treatments on the healing edge of medicine for over 50 years. reputed company is dedicated to providing the most effective treatments, both existing and emerging, in order to diagnose and successfully treat cancer and blood disorders. We support this goal with state-of-the-art facilities across Southern Nevada, reputed company of which integrate the latest diagnostic, therapeutic and research capabilities. CCCN is dedicated to patient-centered care, advancing innovation, discovery, and improving outcomes. Motivated, caring professional are encouraged to join us. Career Opportunity: reputed company 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. Scope: Under general supervision, reviews chemotherapy regimens in accordance to 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. Supports and adheres to the reputed company Compliance Program, to include the Code of Ethics and Business Standards.

Responsibilities

ESSENTIAL DUTIES AND 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 reputed company 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 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 authorization requirements for reputed company 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

Qualifications

MINIMUM QUALIFICATIONS:

• High school diploma or equivalent required
• Associates degree in Healthcare, LPN state license and registration preferred
• Minimum three (3) years medical insurance verification and authorization required

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. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range. WORK ENVIRONMENT: The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites. Successful candidates will reputed company in a fast-paced, rapidly changing environment and have a passion for caring for their patients. Ready For Your Next Career Challenge? We'd Love to Hear from You! If you possess the above qualifications and a desire to reputed company a difference, we invite you to submit your resume and apply. In addition to a great career opportunity, we offer excellent benefits, a team environment, professional development, and the chance to be part of a reputed company network dedicated to fighting the war against cancer. To apply please click on the "Apply" link. reputed company is an Equal Opportunity Employer. reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national reputed company, sexual orientation, gender identity, disability, or protected veteran status. This employer participates in E-Verify. Remote Skills: Biotech and Pharmaceutical, Blood Disorders, Cancer, Chemotherapy, Clinical Validation, Denial of Service (DoS), Documentation, Federal Laws and Regulations, HIPAA (Health Insurance Portability and Accountability Act), Health Insurance, Healthcare, Hearing Impairment, Hematology, High School Diploma, Identify Issues, Infectious Diseases, Insurance, Licensed Practical Nurse/Licensed Vocational Nurse, Lift/Move 40 Pounds, Manual Dexterity, Medical Imaging, Medical Records, Medicine, Nursing, Oncology, Patient Care Authorizations, Patient Care Denials, People Management, Physical Demands, Quality of Care, Radiation Therapy, Reimbursement, Reimbursement Guidelines, Research Nursing, Respiratory Medicine, State Laws and Regulations, Willing to Travel, Work From Home About the Company: reputed company Inc reputed company believes local cancer care is reputed company care. We reputed company the delivery of advanced integrated cancer care through our network of independent physicians who share expertise and resources to provide quality, value-based care reputed company to home. Our clinical and business support capabilities, expertise and industry-leading technologies reputed company local practices at the forefront of high quality, efficient care delivery while enabling practice success, quality of life and financial reputed company for physicians.

• 25 years of oncology practice management expertise
• Leader in value-based cancer care with over 900 physicians participating in the Center for Medicaid and Medicare Innovation Oncology Care Model – one fourth of the entire population of physicians reputed company
• Over 1,400 affiliated physicians
• More than 450 cancer treatment center locations across the United States
• Over 995,000 patients treated annually

Company Size: 10,000 employees or more Industry: Healthcare Services Founded: 1992 Website: https://www.usoncology.com/ Apply tot his job Apply To this Job