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Maryland Oncology Hematology · 12 hours ago

Insurance Reviewer

Wichita, KS

Full-time

Onsite

Mid Level

3+ years exp

Maryland Oncology Hematology is seeking a full-time Insurance Reviewer to join their Wichita, KS office. This role involves reviewing chemotherapy regimens and orders to ensure compliance with reimbursement guidelines and obtaining necessary pre-certifications to avoid delays in treatment reimbursement.

Health CareHospitalMedicalOncology

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 if necessary to, and then when necessary, obtain prior-authorization

Receives and reviews clinical documents within the electronic medical record (“EMR”) in order to meet requirements for obtaining the authorization

Services responsible for obtaining prior authorizations for may include 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 effectively navigating company websites, managed care portals and through methods such as phone and fax in order to complete prior authorization information requests for ordered services

Timely and accurate entry of information in the PMS and EMR

Follows the status of authorizations and referrals to ensure timely receipt

Ability to multi-task and communicate 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 and in part, demonstrates knowledge of Adheres to confidentiality, state, federal, and HIPPA (Health Insurance Portability and Accountability Act) laws and guidelines with regards to patient’s records and information

Attends required, applicable meetings

Remains current on all compliance requirements

Ensures all applicable policies and procedures of the company and Network are followed

Other duties as requested or assigned including coverage within the department

Performs other tasks as reasonably requested by a provider or member of the Management Team, as applicable to the role

Qualification

Medical insurance verificationPrior authorizationHealthcare knowledgeElectronic medical record (EMR)Sound judgmentQuality commitmentTeam-orientedAdaptability