Insurance Coordinator

Essential Job Functions

Clearview Cancer Institute is north Alabama's leading cancer treatment facility. For over 30 years Clearview Cancer Institute has provided leading-edge treatment and compassionate care to those diagnosed with cancer or blood disorders. Clearview offers every service and amenity needed in an outpatient setting and our dedication to research and involvement in Phase I-IV clinical trials gives our patients the opportunity to receive potentially life-saving treatment options.

We are looking for talented and highly-motivated individuals who demonstrate a natural desire to support the meaningful work of community oncologists and the patients we serve.

The following are essential job functions:

• Verifies patient insurance information and benefits for assigned physicians on a rotational schedule.
• Obtains initial and extending authorizations/pre approvals and referrals as required from various carriers in a timely manner, requesting input from appropriate team members as needed.
• Schedules peer to peer reviews for insurance pre approval/authorization denials.
• Communicates clinical information of a denial to the physician and other appropriate parties.
• Informs physician of the information needed to complete the peer to peer review and offers a recommendation on how to handle the case as applicable.
• Monitors entire process ensuring a resolution.
• Stays updated on the insurance guidelines for radiation oncology benefits, the eviCore guidelines and all other payers with specific radiation oncology guidelines. Communicates any changes/and or problems to Compliance.
• Documents insurance and other pertinent patient information obtained through the Referral/Insurance Verification process in the EMR (ARIA) and communicates insurance information to pertinent staff as necessary.
• Checks insurance eligibility for patients annually and more often as assigned for certain insurance carriers as necessary.
• Assists with charge review.
• Completes insurance medical records requests.
• Assists with final treatment audits.
• Assists with Provider Credentialing Specialist for assigned physicians.
• Reviews daily IGRT.
• Tracks a significant amount of data and information related to insurance pre approvals, denials, and peer to peer review outcomes.
• Assists in the development, organization and maintenance of role specific documents, policies, and tools.