Billing Coordinator, Oncology

Position : Billing Coordinator, Oncology

Position Summary

Performs prior authorization/certification of scheduled services with payers & assist with appeal process when needed. Provides clinical review and document submission of pre-certification requests for oncology treatments plans and services. Interfaces with payers on plan medical coverage policies. Verifies eligibility and insurance details on cancer center patients including medical oncology, genetics and other applicable center services. Performs all duties as related to daily charge compliance reviews and reconciliation. Collaborates with billing and medical personnel on resolution of coding issues as required.

Accountabilities

• Performs clinical review and document submission to obtain pre- certification/authorization requests for chemotherapy and non-chemotherapy plans, radiation therapy and advance imaging and blood management plans to support patient treatment and follow-up.
• Completes consistent review of individual payer policies to identify changes affecting authorizations. Maintains current knowledge on medical criteria relating to prior authorization requirements by third party payers and medical necessity requirements.
• Reviews and assists with denial management reports as instructed. Identifies and reports any payer trends, denial patterns and delays to management.
• Communicates with cancer center staff regarding authorization status and decisions as appropriate.
• Participate in process development and improvement as it relates to authorizations, communication, education, etc.
• General understanding of coding for hospital and imaging services recommended including review of hospital records.
• Thoroughly documents actions taken in appropriate information system(s).
• Additional responsibilities/duties will be assigned based on team work load and competency.
• Completes verification eligibility and insurance details on cancer center patients including medical oncology, radiation oncology, genetics and other applicable center services.
• Completes in pre-certification/authorization process as needed.
• Thoroughly documents actions taken in appropriate information system(s).
• Performs charge compliance monitoring and submission for all Oncology Revenue generating accounts. Completes charge batch reconciliations. Reviews include:
• Monitors and corrects charges and quantities for oncology procedures (to include but not limited to: acct. number, charge code, etc.)
• Monitors and adjusts patient status changes (e.g. inpatient vs. outpatient)
• Monitors use of series account numbers
• Note: As each patient completes a course of treatment a full review of charge verification will be done.
• Investigates and resolves finance and central billing offices inquires.
• Researches and addresses department specific charge issues, audits, etc.
• Responsible for obtaining documentation to justify/clarify charges. Seeks clarification of coding issues with medical personnel through approved communication channels.
• Communicates with cancer center staff regarding eligibility and charge status as appropriate. Report management:
• Reviews and assists with denial management reports as instructed. Identifies and reports any payer trends, denial patterns and delays to management.
• Creates reports for ProMedica Cancer Institute leadership as requested.
• Maintains current knowledge on medical criteria relating to prior authorization requirements by third party payers and medical necessity requirements.
• Participate in process development and improvement as it relates to eligibility and charges, communication, education, etc.
• Additional responsibilities/duties will be assigned based on team work load and competency.
  
  

Required Qualifications

• Have High School Diploma.
• Have demonstrated ability to communicate with medical and administrative staff and patients, understanding levels of care.
• Have strong organizations skills and the ability to multi-task.
• Be able to understand directions and be able to communicate and respond to inquiries; requires effective interpersonal and telephone/electronic messaging etiquette skills.
• Have intermediate computer knowledge, skills and proficiency including general office
  
  

applications.

• Demonstrate the ability to accurately and independently solve problems.
• Have the ability to manage large volumes of work, ability to quickly learn and retain information regarding issues that present themselves.
  
  

Preferred Qualifications

Associate’s degree preferred. Oncology experience preferred. Specific knowledge of medical payers recommended. EPIC electronic health record experience is highly desirable.

Additional Experience

Prior oncology eligibility verification and charge compliance duties. Familiarity with ICD10 and CPT codes applicable to services rendered. Experience with electronic record interfaces.

Insight is Equal Opportunity Employer and values workplace diversity.