Remote Oncology Insurance Authorization Specialist

US Oncology Inc.; Henderson (NV); À distance; USD 52 000 - 76 000; Plein temps

Résumé du poste

Comprehensive Cancer Centers of Nevada (CCCN) seeks a Remote Insurance Prior Authorization Specialist in Southern Nevada to review chemotherapy regimens for medical necessity and obtain necessary pre-certifications. You will work with nursing and medical staff to ensure pathways align with payer guidelines and minimize reimbursement delays.

Responsibilities include updating payer guidelines, using EMR and payer portals, and researching alternatives to cover non-covered services while maintaining

Qualifications

• High school degree or equivalent.
• Associates degree in Healthcare, LPN state license and registration preferred.
• Minimum three (3) years medical insurance verification and authorization required.

Responsabilités

• Reviews, processes and audits the medical necessity for each patient’s chemotherapy treatment and documentation of regimen relative to pathway adherence.
• Communicate with nursing and medical staff to inform them of restrictions or special requirements in accordance with insurance plans.
• Updates coding/payer guidelines for clinical staff and tracks pathways.
• Obtains insurance authorization and pre-certification for chemotherapy services; acts as a liaison between patient and payer to avoid delays.
• Uses multiple EMR, payor portals and third-party online portals to submit authorization or verify coverage.
• Researches additional resources for non-covered chemotherapy services to prevent denials and provides community resource contacts.
• Maintains knowledge of chemotherapy authorization requirements for all payers and adheres to HIPAA.

Connaissances

Insurance verification

Pre-certification

EMR systems

Formation

High school degree or equivalent

Associates degree in Healthcare, LPN license preferred

Outils

EMR systems

Payor portals

Third-party portals

Description du poste

Comprehensive Cancer Centers of Nevada (CCCN) seeks a Remote Insurance Prior Authorization Specialist in Southern Nevada to review chemotherapy regimens for medical necessity and obtain necessary pre-certifications. You will work with nursing and medical staff to ensure pathways align with payer guidelines and minimize reimbursement delays.

Responsibilities include updating payer guidelines, using EMR and payer portals, and researching alternatives to cover non-covered services while maintaining