Job Information
Cancer Center of Kansas Insurnace Reviewer - Clinical in Wichita, Kansas
This job was posted by https://www.kansasworks.com : For more information, please see: https://www.kansasworks.com/jobs/13045955
ESSENTIAL DUTIES AND RESPONSIBILITIES:\ \
-Obtains prior authorization for scans, labs, subsequent chemotherapy visits or any other service as required. Maintain 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. Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patient*s records.\ \ -Other duties as requested or assigned.