The US Oncology Network is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.
Outside Scheduler/Insurance Reviewer Sr
Location
United States
Posted
2 days ago
Salary
0
Seniority
Senior
No structured requirement data.
Job Description
Outside Scheduler/Insurance Reviewer Sr
The US Oncology Network
Role Description Texas Oncology is looking for an Outside Scheduler/Insurance Reviewer Sr to join our team! This is a REMOTE position that will support the West Region locations (Odessa, Midland, Wichita Falls, Amarillo, Abilene, and El Paso). Hours are M-F, 8A-5P. What does the Outside Scheduler/Insurance Reviewer Sr do? (including but not limited to) - Under minimal supervision, dedicated to outside scheduling of physician referrals and/or outside 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 lower-level employees. - Serves as a liaison between patients, medical staff, and referring offices. - Operates within standard procedures and pre-established guidelines to complete tasks. - Supports and adheres to the US Oncology Compliance Program, including the Code of Ethics and Business Standards. Responsibilities - 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 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 specifically for chemotherapy 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, pharmaceutical supplies, and financial resources. - 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 records. - Other duties as requested or assigned. Qualifications - 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 a quick learner in the technical/functional area; accesses and uses other expert resources when 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 resilience 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 efficiently to achieve them. - 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; manages quality; improves efficiencies. Physical Demands - Work may require sitting for long periods of time; also stooping, bending, and stretching for files and supplies. - Occasionally lifting files or paper 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 - Work is performed in an office environment. - Involves contact with patients and the public.
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