Treatment Analyst

Job Description The Treatment Analyst representative works with insurance companies to authorize various treatment services including chemotherapy, infusions, and injectables. The Treatment Analyst demonstrates a high level of accountability to ensure accurate selection of insurance, documentation of benefits coverage, and submission of necessary preauthorization to ensure no delay in reimbursement of treatment. The successful candidate will be flexible and be able to multi‑task in a fast‑paced, high‑volume setting. Our ideal candidate has a fundamental understanding of how insurance verification and pre‑certification impacts the revenue cycle as well as PCI patients. Previous insurance verification and prior authorization experience is crucial for success in this role, experience in oncology preferred. Responsibilities Contact insurance companies to determine pre‑authorization requirements for all chemotherapy, injectables, infusions or other treatments – including OPI treatment. Review and submit clinical information to support medical necessity for treatment, verifying the completeness and accuracy of all information before submission. Call insurance companies or use online tools to obtain pre‑authorization prior to service date and follow‑up timely and thoroughly. Utilize reports to initiate pre‑authorization on treatment and ensure authorization is in place at least 48 hours prior to the scheduled treatment. Ensure authorization details for all treatment services are documented in the patient’s record and within the Business Office link of OncoEMR. Review chemotherapy/treatment regimens in accordance to reimbursement and medical necessity guidelines. Provide feedback to IVR/Treatment Analysis supervisor regarding documentation issues and payer issues with non‑covered chemotherapy drugs. Coordinate with clinic staff to inform them of any restrictions or special requirements regarding specific insurance plans. Coordinate with front office staff and IVR to ensure accurate insurance information is submitted and verified before all treatments. Confirm that verification details for all treatments are documented in the patient’s record. Act as liaison between clinical staff, patients, IVR and insurance by informing all parties of coverage or pre‑certification issues, including answering questions, helping, and relaying messages pertaining to verification and pre‑certification. Maintain an advanced knowledge of authorization requirements for all payers including state and federal regulations for coverage and authorization. Multi‑task and use time efficiently; perform professionally at a high level under tight deadlines and in a fast paced ever‑evolving work environment, successfully prioritize, and adapt to changing demands. Identify problems or trending issues, provide suggestions for findings, and determine solutions. Communicate issues to management, including payer, system or escalated account issues. Respond timely to emails and telephone messages as appropriate. Regularly meet with IVR/Treatment Analysis Supervisor to discuss and resolve verification issues or pre‑authorization obstacles. Regularly attend weekly/monthly department meetings and monthly Revenue Cycle Department meetings. Other duties as assigned. Abide by HIPAA when handling any and all protected health information (PHI). Qualifications High school diploma (or equivalent) is required; collegiate education preferred. Three+ years of medical office experience preferred with demonstrated skills in problem solving, attention to detail, ability to learn and use multiple systems and effective written and verbal communication skills. Advanced technical skills including PC and MS Outlook. Advanced knowledge of health insurance benefits including copay, deductible, co‑insurance for In‑network & out‑of‑network services. Advanced knowledge of pre‑certification including infusion, injectables and other forms of chemotherapy. Advanced knowledge of CPT, HCPCS, and ICD‑10 codes. Advanced knowledge of medical terminology and business office processes. Hematology/Oncology experience strongly preferred, however, not required. Strong interpersonal skills, customer service experience, and the ability to prioritize, work accurately, work well independently and maintain focus under pressure. Must be able to sit 8 hours/day and work through occasional high stress situations. Exposure to general indoor working conditions. Employment Information Job Type: Full‑time Pay: From $26.00 per hour Benefits 401(k) Dental insurance Employee assistance program Employee discount Health insurance Life insurance Paid time off Referral program Vision insurance HIPAA Requirements Treatment Analysis will have access to PHI and ePHI in the course of his/her duties. Applying the minimum necessary standard of HIPAA, this employee has access to the minimum amount of designated record sets required to perform his or her duties. Piedmont Cancer Institute is an Equal Opportunity Employer. #J-18808-Ljbffr Astera Cancer Care