Duke Cancer Institute · 1 day ago

Reimbursement Specialist - Outpatient Medication Authorization - Remote

Durham, NC

Full-time

Remote

Mid Level

4+ years exp

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Responsibilities

Perform regular quality audit/control reviews on internal and external staff according to department policies and procedures. Requires review of authorization denials and analysis to determine/assign root-cause.

Maintain electronic documentation files to record all quality scores, maintaining compliance guidelines.

Trend and report overall quality scores and feedback on the team's performance.

Meet with management regularly to share audit findings and results.

Respond to audit questions/discrepancies timely and in accordance with department policies and procedures.

Support management/supervisors in overseeing outsourced vendor books of business to ensure inventory, productivity, and quality guidelines are achieved and maintained as defined by department contracts.

Aid in the oversight of work queue inventories, productivity/quality reporting, and confirmation of monthly invoicing.

Respond to external staff questions timely regarding accounts or process as defined by department policies and procedures.

Communicate process changes and training to vendors as needed.

Attend and participate in regularly scheduled meetings with outsourced vendors as assigned.

Research accounts and respond with accurate findings/instructions in a timely manner.

Interact with and provide verbal/written responses to all stakeholders (patients, providers, payors, and departmental personnel).

Participate in the development of operational goals and objectives for the team; recommend, implement, and administer processes and procedures to enhance workflow.

Assist management in training documentation related to findings from quality reviews/audits.

Attend and/or facilitate regular training sessions to maintain knowledge of practice/protocol related to timely filing adjustments as needed.

Partner with supporting clinics to educate on authorization processes and resolve problems relating to patient appointments/admissions as needed.

Conduct observations of staff/process to look for operational improvements and share recommendations with management.

Acknowledge management requests and emails in a professional, timely manner.

Attend meetings and participate on committees as assigned.

Actively participate in Work Culture initiatives.

Accomplish all tasks as assigned.

Qualification

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Quality AuditingInsurance VerificationHealthcare ExperienceAccountingFinanceEconomicsBusiness Administration

Required

High school diploma or equivalent is required, preferably supplemented by post-secondary courses in Accounting, Finance, Economics, Business Administration or a related field.

Four years of related experience in healthcare is required. A Bachelor's degree in a related field can substitute for the experience requirement.