Medical Necessity Reviewer

7 days ago


Colorado Springs, Colorado, United States Rocky Mountain Cancer Centers Full time
Job Summary

We are seeking an experienced Authorization Specialist to join our team at Rocky Mountain Cancer Centers. As a key member of our team, you will be responsible for reviewing and processing medical necessity for chemotherapy treatments, working with patients and payers to resolve insurance issues, and ensuring compliance with regulatory guidelines.

Responsibilities
  • Review and process medical necessity for chemotherapy treatments, ensuring compliance with regulatory guidelines.
  • Work with patients and payers to resolve insurance issues, including obtaining authorization and pre-certification for chemotherapy services.
  • Research and identify additional or alternative resources for non-covered services to prevent payment denials.
  • Communicate with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans.
  • Prepare and submit write-off requests with appropriate documentation.
  • Process insurance/patient correspondence, including denial follow-up and maintain reimbursement correspondence and filing systems.
  • Maintain a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization.
Requirements
  • High school degree or equivalent.
  • Minimum two (2) years medical insurance verification and authorization experience.
  • Billing and coding experience preferred.
Working Conditions

The work environment is an office setting with frequent interaction with patients, clinical and business office staff, and payers.



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