Insurance Reviewer - Clinical jobs in United States
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Maryland Oncology Hematology · 1 month ago

Insurance Reviewer - Clinical

positionEugene, OR
timeFull-time
remoteOnsite
seniorityMid Level
money$22.01/hr - $31/hr
date3+ years exp

Maryland Oncology Hematology is seeking an Insurance Reviewer to support patients receiving necessary testing and treatment by navigating insurance portals and obtaining authorizations. The role involves reviewing medical necessity for treatments, communicating with medical staff regarding insurance requirements, and maintaining knowledge of authorization guidelines.

Health CareHospitalMedicalOncology

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. Documentation of regimen related to pathway adherence and payer guidelines
Communicate 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
Other duties as requested or assigned

Qualification

Prior authorization experienceRevenue cycle experienceHIPAACommunication skillsAttention to detail

Required

High school degree or equivalent
Minimum three (3) years of prior authorization experience required

Preferred

Revenue cycle experience preferred

Benefits

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

Company

Maryland Oncology Hematology

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Maryland Oncology Hematology is a community based healthcare institution specialized in research and treatment of cancer patients.
dateFounded in 1986
location
Columbia, Maryland, USA
people-size501-1000 employees
web-link
https://marylandoncology.com/

Funding

Current Stage
Late Stage

Leadership Team

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David Weng
Partner
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Recent News

Maryland Daily Record
$7.25M medical malpractice verdict may be largest in Howard County history
2024-12-17
PR.com
George Sotos, MD Named Practice President of Maryland Oncology Hematology
2022-07-08
PR.com
Experienced Hematologist and Medical Oncologist Harminder Sethi, MD joins Maryland Oncology Hematology
2022-03-30
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