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Clinical Insurance Specialist
2 months ago
The Cancer Center of Kansas is committed to providing exceptional care to our patients, and we are seeking a highly skilled Clinical Insurance Specialist to join our team. As a Clinical Insurance Specialist, you will play a critical role in ensuring that our patients receive the necessary treatments and services in a timely and efficient manner.
Responsibilities- Obtain prior authorization for scans, labs, subsequent chemotherapy visits, or any other service as required.
- Assist in receiving and reviewing orders from CCK providers to analyze if necessary to, and then when necessary, obtain prior authorization.
- Receive and review 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.
- Contact referring physicians and facilities to obtain referrals for all services scheduled at CCK.
- Provide clinical information to insurance companies and case managers as needed.
- Coordinate peer-to-peer calls between physicians and insurance companies.
- Assist in maintaining up-to-date information on insurance requirements for all authorization needs per payer.
- Upload and attach authorizations and referrals to the practice management system (PMS) and EMR as needed.
- Contact 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.
- Follow the status of authorizations and referrals to ensure timely receipt.
- Ability to multi-task and communicate through various mediums.
- Maintain a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization.
- 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 in 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 of performance; pursues aggressive goals and works efficiently to achieve them.
- Commits to Quality: Emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluates products, processes, and service against those standards; manages quality; improves efficiencies.
