Maryland Oncology Hematology · 15 hours ago
Insurance Clinical Reviewer
Fort Worth, TX
Full-time
Onsite
Entry, Mid, Senior Level
3+ years expMaryland Oncology Hematology is part of The US Oncology Network, which delivers high-quality cancer care to patients. They are seeking a Clinical Insurance Reviewer to review chemotherapy regimens for reimbursement compliance, obtain pre-certifications, and serve as a liaison between patients and payers to ensure timely treatment funding.
Health CareHospitalMedicalOncology
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 and 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 HIPPA laws and guidelines with regards to patient’s records
Other duties as requested or assigned
Qualification
Required
High school degree or equivalent
Minimum three (3) years medical insurance verification and authorization required for Level Sr
Minimum three (3) years medical insurance verification and authorization required for Level 1
Preferred
Associates degree in Healthcare, LPN state license and registration preferred
Minimum three (3) years medical insurance verification and authorization preferred
Company
Maryland Oncology Hematology
Maryland Oncology Hematology is a community based healthcare institution specialized in research and treatment of cancer patients.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
David Weng
Partner
Recent News
Maryland Daily Record
2024-12-17
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