The US Oncology Network · 2 days ago
Insurance Reviewer
Wichita, KS
Full-time
Onsite
Mid Level
3+ years expThe Cancer Center of Kansas (CCK) is part of The US Oncology Network, dedicated to providing quality cancer care across Kansas. They are seeking a full-time Insurance Reviewer who will be responsible for reviewing chemotherapy regimens and orders, obtaining necessary pre-certifications, and ensuring compliance with reimbursement guidelines.
CommunitiesHealth CareMedicalOncologyTest and Measurement
Responsibilities
Obtains prior authorization for scans, labs, subsequent chemotherapy visits or any other service as required
Maintains a professional working relationship with co-workers, insurance companies and referring doctor offices
Assists in receiving and reviewing orders from CCK providers to analyze if necessary to, and then when necessary, obtain prior-authorization
Receives and reviews clinical documents within the electronic medical record (“EMR”) in order to meet requirements for obtaining the authorization
Services responsible for obtaining prior authorizations for may include radiology, laboratory, chemotherapy and injections
Contacts referring physicians and facilities to obtain referrals for all services scheduled at CCK
Provides clinical information to insurance companies and case managers as needed
Coordinates peer to peer calls between physicians and insurance companies
Assists in maintaining up to date information on insurance requirements for all authorization needs per payer
Uploads and attaches authorizations and referrals to the practice management system (“PMS”) and EMR as needed
Contacts insurance companies through effectively navigating company websites, managed care portals and through methods such as phone and fax in order to complete prior authorization information requests for ordered services
Timely and accurate entry of information in the PMS and EMR
Follows the status of authorizations and referrals to ensure timely receipt
Ability to multi-task and communicate through various mediums
Maintains a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization
Remains current on all compliance requirements and in part, demonstrates knowledge of Adheres to confidentiality, state, federal, and HIPPA (Health Insurance Portability and Accountability Act) laws and guidelines with regards to patient’s records and information
Attends required, applicable meetings
Remains current on all compliance requirements
Ensures all applicable policies and procedures of the company and Network are followed
Other duties as requested or assigned including coverage within the department
Performs other tasks as reasonably requested by a provider or member of the Management Team, as applicable to the role
Qualification
Required
High school degree or equivalent
Minimum three (3) years medical insurance verification and authorization required
Preferred
Associates degree in Healthcare or Business-related preferred
Benefits
Medical Health Care
Dental Care
Vision Plan
401-K with a matching component
Life Insurance
Short-term and Long-term disability
FSA and HSA
Legal Insurance
Competitive Paid Time Off Plan
Wellness & Perks Programs
Company
The US Oncology Network
Every day, The US Oncology Network helps approximately 3,300 providers deliver value-based, integrated care for patients—close to home.
10001+ employees
H1B Sponsorship
The US Oncology Network has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2023 (1)
Funding
Current Stage
Late StageTotal Funding
unknown2010-12-30Acquired
Leadership Team
R. Steve Paulson
National Policy Board Executive Committee
Recent News
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