Insurance Prior Authorization Specialist - Remote; Southern

At Comprehensive Cancer Centers of Nevada (CCCN) a distinguished team of doctors, researchers, nurses, and healthcare professionals have provided patients with groundbreaking treatments on the healing edge of medicine for over 50 years. Our team provides the most effective treatments, both existing and emerging, to diagnose and successfully treat cancer and blood disorders. We support this goal with state-of-the-art facilities across Southern Nevada, all of which integrate the latest diagnostic, therapeutic, and research capabilities.

CCCN is dedicated to patient-centered care, advancing innovation, discovery, and improving outcomes. Motivated, caring professionals are encouraged to join us.

Comprehensive Cancer Centers of Nevada is seeking a Remote Insurance Prior Authorization Specialist in Southern Nevada only.

Under general supervision, reviews chemotherapy regimens in accordance with reimbursement guidelines. Obtains necessary pre-certifications and exceptions to ensure no delay in reimbursement of treatments. Researches denied services and alternative resources to pay for treatment. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards.

• 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 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 perform 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.
• Ability to use multiple EMR, payor portals and third-party online web portals to electronically submit authorization or verify that the ordered service is a covered benefit of the health plan.
• Research additional or alternative resources for non-covered chemotherapy services to prevent payment denials. Provides a contact list for patient’s 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 HIPAA laws and guidelines with regards to patients’ records.
• Other duties as requested or assigned.

• 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.

• 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 when appropriate.
• Demonstrates Adaptability:
  Handles day to day work challenges confidently; is willing and able to adjust to multiple demands, shifting priorities, ambiguity and rapid change; shows resilience inn the face of constraints, frustrations, or adversity; demonstrates flexibility.
• Uses Sound Judgment:
  Makes timely, cost effective and sound decisions; makes decisions under conditions of uncertainty.
• Shows Work Commitment:
  Sets high standards…