Clinical Insurance Reviewer

  • location: Irving, TX
  • type: Contract
  • salary: $18 - $20 per hour
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job description

Clinical Insurance Reviewer

job summary:
Clinical Insurance Reviewer - Flower Mound, TX

  • This is 1 contract role expected to last 2 months
Clinical Insurance Reviewer - Job Duties:

  • Reviews, processes and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence.
  • Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans. Provides prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered chemotherapy drugs.
  • Updates coding/payer guidelines for clinical staff. Tracks pathways and performs various other business office functions on an as needed basis
  • Obtains insurance authorization and pre-certification specifically for chemotherapy services. Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
  • Researches additional or alternative resources for non-covered chemotherapy services to prevent payment denials. Provides a contact list for patients community resources including special programs, drugs and pharmaceutical supplies and financial resources.
  • Maintains a good working knowledge of chemotherapy authorization requirements for all 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.
Job Requirements:

  • High School Diploma or equivalent required
  • 1+ years of insurance experience required
Compensation: $18-$20/hr

 
location: Irving, Texas
job type: Contract
salary: $18 - 20 per hour
work hours: 9 to 5
education: High School
experience: 1 Years
 
responsibilities:
Requirements:-Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans. Provides prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered chemotherapy drugs.

-Updates coding/payer guidelines for clinical staff. Tracks pathways and performs various other business office functions on an as needed basis

- Obtains insurance authorization and pre-certification specifically for chemotherapy services. Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.

-Researches additional or alternative resources for non-covered chemotherapy services to prevent payment denials. Provides a contact list for patients community resources including special programs, drugs and pharmaceutical supplies and financial resources.

-Maintains a good working knowledge of chemotherapy authorization requirements for all 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.

 
qualifications:
Qualifications:

High School Diploma or equivalent required

1+ years of payroll experience required

 
skills: Data Processor
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

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