Insurance Reviewer

Responsibilities

• Reviews, processes and audits the medical necessity for treatments including radiation oncology, gynecologic surgery, genetic lab testing, imaging, and chemotherapy treatment for each patient.
• Documents regimen related to pathway adherence and payer guidelines.
• Communicates with nursing, physician, pharmacists 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 pathway documentation issues, and payer issues with non-covered chemotherapy drugs.
• Updates coding/payer guidelines for clinical staff.
• Tracks pathways and performs various other business office functions on an as needed basis.
• Obtains insurance authorization and pre-certification for various oncology & hematology related services.
• Maintains a good working knowledge of chemotherapy authorization requirements for all 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.

Qualifications

• A high school degree or equivalent.
• Minimum three (3) years of prior authorization experience required.
• Revenue cycle experience preferred.

Pay

The general pay scale for this position at WVCI is $22.00-$32.00. The actual hiring rate is dependent on many factors, including but not limited to: prior work experience, education, job/position responsibilities, location, work performance, internal equity, etc.

Schedule

Full Time

Benefits

M/D/V, Life Ins., 401(k)

Physical Demands

Reasonable accommodations may be made to enable individuals with disabilities to perform 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.