Insurance Reviewer-Clinical

The Cancer Center of Kansas (CCK) is seeking a full-time, on-site Insurance Reviewer to join our team in Wichita, KS. As part of The US Oncology Network, CCK delivers quality, personalized cancer care to communities across the state, with physicians and staff treating patients in over 18 locations.

Schedule

Monday through Friday, 8:30 AM – 5:00 PM. No major holidays, no on-call, and no weekends.

Benefits

• 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

Responsibilities

• 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 and obtain prior-authorization when necessary.
• Reviews clinical documents within the electronic medical record (EMR) to meet requirements for obtaining authorization.
• Obtains prior authorizations for 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 websites, managed care portals, phone, and fax to complete prior authorization requests.
• Ensures timely and accurate entry of information in the PMS and EMR.
• Follows the status of authorizations and referrals to ensure timely receipt.
• Multi-tasks and communicates 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, including HIPAA laws and guidelines regarding patient records.
• Attends required meetings and ensures adherence to company and Network policies and procedures.
• Performs other duties as requested or assigned, including coverage within the department.

Requirements

• High school degree or equivalent; Associates degree in Healthcare or Business-related field preferred.
• Minimum three (3) years of medical insurance verification and authorization experience required.

Skills

• Uses Technical and Functional Experience: Possesses up-to-date knowledge of the profession and industry; accesses and uses other expert resources when appropriate.
• Demonstrates Adaptability: Handles day-to-day work challenges confidently; adjusts to multiple demands, shifting priorities, ambiguity, and rapid change; shows resilience in the face of constraints, frustrations, or adversity.
• 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 efficiently to achieve them.
• Demonstrates Team-Oriented Characteristics: Fosters a positive and productive team environment by working effectively with others and offering help when able.
• Commits to Quality: Emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluates products, processes, and service against those standards; improves efficiencies.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Regularly required to sit or stand, talk, or hear during scheduled business hours.
• 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

• May include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other conditions common to an oncology/hematology clinic environment.
• Involves in-person interaction with co-workers, management, and/or clients.
• May require minimal travel by automobile to office sites.