Rocky Mountain Cancer Centers, Colorado’s largest and most comprehensive provider of cancer care has an exciting opportunity for an experienced authorization specialist in Greenwood Village, CO.
The successful candidate will:
-Review, process and audit the medical necessity for each patient chemotherapy treatment and documentation of regimen and pathway adherence (including review of ICD-10 diagnosis codes)
-Work as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays. Obtain insurance authorization and pre-certification for chemotherapy services.
-Communicate with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans. Provide prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered chemotherapy drugs.
-Communicate back to site on insurance update/status within 24 hours of receipt of authorization request; stat requests require same day update on insurance authorization to providers
-Process insurance/patient correspondence, including denial follow-up. Maintain reimbursement correspondence and filing systems
-Report any problems, issues or payer trends.
-Maintain a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization. Comply with patient confidentiality laws and regulations.
-Update coding/payer guidelines for clinical staff and adheres to NCCN guidelines with obtaining authorization. Track pathways and performs various other business office functions on an as needed basis.
High school degree or equivalent. Associates degree in healthcare preferred. Minimum two (2) years medical insurance verification and authorization required. Billing and coding experience preferred.
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 employee is regularly required to experience prolonged sitting, some bending, stooping and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and vision correctable to 20/20. Requires occasional lifting of up to 30 pounds.
All qualified candidates are required to pass a background check and non-federal drug test (which excludes marijuana) post offer of employment and prior to hire
The US Oncology Network is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
Job Type: Full-time
- insurance authorization: 1 year (Preferred)
- High school or equivalent (Required)
- Health insurance
- Dental insurance
- Vision insurance
- Paid time off
- Tuition reimbursement