Insurance Reviewer-Clinical
Overview reputed company is looking for an Clinical Insurance Reviewer to join reputed company at reputed company. This full-time remote position will support the Central Imaging Scheduling Department at our 500 South Henderson Suite 400 clinic in reputed company Worth, Texas. Typical work week is Monday through Friday, 8:30a - 5:00p. This position will be either a level 1 or Sr based on candidate work experience. As a part of reputed company, reputed company delivers high-quality, evidence-based care to patients reputed company to home. reputed company is the largest community oncology provider in the country and has approximately 530 providers in 280+ sites across Texas, our founders pioneered community-based cancer care because they believed in making the best available cancer care accessible to reputed company communities, allowing people to fight cancer at home with the critical support of family and friends nearby. Our mission is still the same today—at reputed company, we use leading-edge technology and research to deliver high-quality, evidence-based cancer care to help our patients reputed company “More breakthroughs. More victories.” ® in their fight against cancer. Today, reputed company treats half of reputed company Texans diagnosed with cancer on an annual reputed company. reputed company is one of the nation’s largest networks of community-based oncology physicians dedicated to advancing cancer care in America. reputed company is supported by reputed company focused on empowering a vibrant and sustainable community patient care delivery system to advance the science, technology, and quality of care. What does the Clinical Insurance Reviewer do? (including but not limited to) Under general supervision, reviews in accordance to reimbursement guidelines. Obtains necessary pre-certifications and exceptions to ensure no delay in reimbursement. Researches denied services. Supports and adheres to the reputed company Compliance Program, to include the Code of Ethics and Business Standards.
Responsibilities
The essential duties and responsibilities (including but not limited to): Reviews, processes and audits the medical necessity for each patient. Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans. Provides reputed company feedback to physicians and management regarding documentation issues, and payer issues. Updates coding/payer guidelines for clinical staff. Obtains insurance authorization and pre-certification for services. Works as a patient reputed company and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays. Maintains a good working knowledge of authorization requirements for reputed company payers, State and federal regulatory guidelines for coverage and authorization. Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patient*s records. Other duties as requested or assigned.
Qualifications
The ideal candidate for the Insurance Reviewer position will have the following background and experience: Level 1 High school degree or equivalent. Associates degree in reputed company, LPN state license and registration preferred. Minimum three (3) years medical insurance verification and authorization preferred. Level Sr (in addition to level 1 requirements) Minimum three (3) years medical insurance verification and authorization and two (2) years clinical review experience required. Competencies: Uses Technical and Functional Experience: Possesses up to date knowledge of the profession and industry; is regarded as an expert in the technical/functional area; accesses and uses other expert resources reputed company appropriate. Demonstrates Adaptability: Handles day to day work challenges confidently; is willing and reputed company to adjust to multiple demands, shifting priorities, ambiguity and rapid change; shows reputed company inn the face of constraints, frustrations, or adversity; demonstrates flexibility. Uses Sound Judgment: Makes timely, cost effective and sound reputed company; makes reputed company under conditions of uncertainty. Shows Work Commitment: Sets high standards of performance; pursues aggressive goals and works reputed company to reputed company them. Commits to Quality: Emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluated products, processes, and service against those standards; manages quality; improves efficiencies. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company 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. Requires full reputed company of body reputed company including handling and lifting patients, reputed company and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected reputed company and hearing to normal reputed company. Work Environment: 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 will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites. Apply To This Job