Oncology Services Specialist 1

Carle; Urbana (IL); On-site; USD 28,000 - 45,000; Full time

Job summary

Carle Health’s Cancer Services team in Urbana, IL seeks a Cancer Services Specialist to manage pre-authorizations and insurance inquiries. The role coordinates cancer conferences and supports accreditation for CoC and NAPBC, tracking data and maintaining meeting minutes.

Responsibilities include handling authorizations, educating payers and staff, managing denials with appeals, and preparing reports for accreditation surveys.

Qualifications

• Healthcare experience

Responsibilities

• Handles third party payer screening and authorizations for appropriate criteria.
• Obtains, documents, verifies and follows up on insurance authorizations and eligibility for scheduled exams.
• Checks eligibility against carrier databases.
• Notifies staff of authorization updates and changes.
• Educates external customers on authorization procedures.
• Manages and resolves denied cases with appeals.
• Generates denial letters and documents appeal materials.
• Suggests policy changes to prevent denials.
• Ensures correct ICD-10/CPT coding for orders and authorizations.
• Schedules and coordinates Cancer Committee Meetings and cancer conferences.
• Assists with data gathering for accreditation activities.
• Maintains cancer conference case lists and distributes to attendees.
• Records discussion points for ACS reporting.

Job description

Overview

The Cancer Services Specialists is responsible for all the pre-authorizations and insurance inquiries within the cancer center. Understands payment denials and how to prevent denials to reduce losses; works and appropriately appeals the denials from insurance companies. The Cancer Services Specialist coordinates all cancer conferences/tumor boards at CCI-Urbana and CCI-Normal. They are responsible for ensuring all standards for CoC and NAPBC accreditations are met; tracking and entering data into the survey portal, coordinating and maintaining regular meetings of cancer committee and subcommittee and taking minutes. Cancer Services specialist play a key role in accreditation survey prep and reporting.

Qualifications

Certifications: , Education: , Work Experience: Healthcare

Responsibilities

• Assumes primary responsibility in working with the third party payer for screening and authorizations for appropriate criteria/pre-certs/third party approvals
• Obtains, documents, verifies and conducts follow-up on insurance authorizations and insurance eligibility as required for scheduled exams
• Checks insurance eligibility to ensure that the information provided matches the insurance carrier's database information
• Prepares written communication to notify appropriate staff of authorization updates and/or changes for insurance carriers
• Interacts with external customers to inform and educate regarding authorization procedures
• Manages and resolves denied cases. In cooperation with Billing Department, works denials by sending appeal letters and making appropriate contact with insurance companies or billing staff
• Generates timely and compliant denial letters and to facilitate the submission of appropriate appeal documentation
• Provides recommendations for policy and procedure changes to management to prevent or limit denials
• Reviews and ensures diagnostic, ICD-10, and CPT code is utilized for ordering and pre-authorizations
• Schedules, prepares, and coordinates Administrative Cancer Committee Meetings, cancer conferences, and meetings.
• Assists with generating reports and gathering data for providers and staff in relation to accreditation activities.
• Maintains ongoing cancer conference case lists and distributes to attendees in a timely manner.
• Tracks cancer conference discussion to ensure all required elements are discussed for reporting to American College of Surgeons.

About Us

Find it here.

Discover the job, the career, the purpose you were meant for. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities. Find it all at Carle Health.

Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois. We’ve grown to include eight, award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. We’re developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Methodist College. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: [e-mail].

Compensation and Benefits

The compensation range for this position is $20.14per hour - $32.63per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate’s experience, qualifications, location, training, licenses, shifts worked and compensation model. Carle Health offers a comprehensive benefits package for team members and providers. To learn more visit careers.carlehealth.org/benefits.