CANCER SERVICES SPECIALIST

3 weeks ago

Urbana IL USA, United States Carle Foundation Hospital Full time
* Assumes primary responsibility in working with the third party payer for screening and authorizations for appropriate criteria/pre-certs/third party approvals
* Obtains, documents, verifies and conducts follow-up on insurance authorizations and insurance eligibility as required for scheduled exams
* Checks insurance eligibility to ensure that the information provided matches the insurance carrier's database information
* Prepares written communication to notify appropriate staff of authorization updates and/or changes for insurance carriers
* Interacts with external customers to inform and educate regarding authorization procedures
* Manages and resolves denied cases. In cooperation with Billing Department, works denials by sending appeal letters and making appropriate contact with insurance companies or billing staff
* Generates timely and compliant denial letters and to facilitate the submission of appropriate appeal documentation
* Provides recommendations for policy and procedure changes to management to prevent or limit denials
* Reviews and ensures diagnostic, ICD-10, and CPT code is utilized for ordering and pre-authorizations
* Schedules, prepares, and coordinates Administrative Cancer Committee Meetings, cancer conferences, and meetings.
* Assists with generating reports and gathering data for providers and staff in relation to accreditation activities.
* Maintains ongoing cancer conference case lists and distributes to attendees in a timely manner.
* Tracks cancer conference discussion to ensure all required elements are discussed for reporting to American College of Surgeons.
* Competent in at least two (2) claims areas (Diagnostics, Oral Chemo, Infusion, or Radiation) or
* Competent in at least two (2) cancer registry tasks (SAR/PAR completion, Tumor Board Schedule, Prep and Notes, CoC/NAPBC Scheduling, Prep, Notes, or Suvivorship Tracking)

The Cancer Services Specialists is responsible for all the pre-authorizations and insurance inquiries within the cancer center. Understands payment denials and how to prevent denials to reduce losses; works and appropriately appeals the denials from insurance companies. The Cancer Services Specialist coordinates all cancer conferences/tumor boards at CCI-Urbana and CCI-Normal. They are responsible for ensuring all standards for CoC and NAPBC accreditations are met; tracking and entering data into the survey portal, coordinating and maintaining regular meetings of cancer committee and subcommittee and taking minutes. Cancer Services specialist play a key role in accreditation survey prep and reporting.

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