Prior Authorizations- Insurance Reviewer

Insurance Reviewer - Clinical

Willamette Valley Cancer Institute is looking for an Insurance Reviewer to support our patients receiving testing and treatment needed for their diagnosis by navigating insurance portals and obtaining all appropriate authorizations. With a focus on authorizations for infusion drugs, radiation therapy, imaging, genetics and surgeries our Insurance Reviewers pave the way for our patients and treatment team to follow the prescribed treatment pathway. An individual that thrives in a high-volume workspace, with the ability to manage shifting priorities will find success in this role.

The actual hiring rate is dependent on many factors, including but not limited to: prior work experience, education, job/position responsibilities, location, work performance, internal equity, etc.

Employment Type: Full Time

Reviews, processes and audits the medical necessity for treatments including radiation oncology, gynecologic surgery, genetic lab testing, imaging, and chemotherapy treatment for each patient. Communicate with nursing, physician, pharmacists and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans. 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 for various oncology & hematology related services.

Maintains a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization.

Minimum three (3) years of prior authorization experience required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work may require minimal travel by automobile to office sites.

The US Oncology Network is an Equal Opportunity Employer.