Insurance Reviewer-Clinical

Overview The Cancer Center of Kansas (CCK) is seeking a full-time , on-site Insurance Reviewer to join our team in our Wichita , KS offices. The typical work week is Monday through Friday, 8:30 AM – 5:00 PM with no major holidays, no on-call and no weekends. As part of The US Oncology Network and with over 40 years beingestablishedin Kansas, CCK delivers quality, personalized cancer care to communitiesacross the state.Our physicians and staff treat patients in over 18 locations throughout the state. Ourmanagement andphysician teamscontinue tobe recognizedin our communitiesfor Excellence in Healthcare!With our mission in mind, we valueeach and everyemployee for their life-savingexpertiseand the role they play in making our patients’ lives as easy and comfortable as possible. Our employees are our most valuableresource. They help us create and continue to deliver on our mission. Medical Health Care Dental Care Vision Plan 401-K with a matching component Life Insurance Short-term and Long-term disability FSA and HSA Legal Insurance Competitive Paid Time Off Plan Wellness & Perks Programs What does this position entail? This role, under general supervision, reviews chemotherapy regimens and orders in accordancetoreimbursement guidelinesand standard of careadherence. Obtains necessary pre-certifications and exceptions to ensure no delay in reimbursement of treatments. Supports and adheres to the US Oncology Compliance Program,to includethe Code of Ethics and Business Standards. Responsibilities The essential duties and responsibilities of this position are: Obtains prior authorization for scans, labs,subsequentchemotherapyvisitsor any other service asrequired. Maintains a professional working relationship with co-workers, insurancecompaniesand referring doctor offices. Assistsin receiving and reviewing orders from CCK providers to analyze if necessary to, andthenwhen necessary, obtainprior-authorization. Receives and reviews clinical documents within the electronic medical record (“EMR”)in order tomeet requirements for obtaining the authorization. Services responsible for obtaining priorauthorizations formay include radiology, laboratory,chemotherapyand 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. Coordinatespeer to peercalls between physicians and insurance companies. Assistsinmaintainingup to date information on insurance requirements for all authorization needs perpayer. 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 faxin order tocomplete prior authorization information requests for ordered services. Timely andaccurateentry of information in the PMS and EMR. Follows the status of authorizations and referrals to ensuretimelyreceipt. 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,demonstratesknowledge 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 assignedincludingcoverage within the department. Performs other tasks as reasonably requested by a provider or member of the Management Team, as applicable to the role. Supervisory Responsibilities None. Qualifications The ideal candidate for the position will have the following qualifications: Minimum Qualifications: High school degree or equivalent. Associates degree in Healthcareor Business-related preferred. Minimum three (3)yearsmedical insurance verification and authorization required. Competencies: Uses Technical and Functional Experience:Possessesup to date knowledge of the profession and industry; is regarded as an expert in the technical/functional area; accesses and uses other expert resources whenappropriate. Demonstrates Adaptability: Handles day to day work challenges confidently; is willing and able to adjust to multiple demands, shifting priorities,ambiguityand rapid change; shows resilienceinnthe face of constraints, frustrations, or adversity;demonstratesflexibility. Uses Sound Judgment: Makes timely, cost effective and sound decisions; makes decisions under conditions of uncertainty. Shows Work Commitment: Setshigh standardsof performance; pursues aggressive goals and works efficiently to achieve them. Demonstrates Team-Oriented Characteristics: Fosters a positive and productive teamenvironmentby working effectively with othersand offering help when able. Commits to Quality: Emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluated products, processes, and service against those standards; manages quality; improvesefficiencies. Physical Demands of the Job: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employeeis required tobe present at theemployeesite during regularly scheduled business hours and regularlyrequiredto sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range. WorkEnvironment: The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medicalpreparationsand other conditions common to anoncology/hematology clinic environment. Work will involve in-person interaction with co-workers andmanagementand/or clients. Work may require minimal travel by automobile to office sites. #J-18808-Ljbffr US Oncology Inc.