Billing Coordinator, Oncology

POSITION SUMMARYPerforms prior authorization / certification of scheduled services with payers and assists with the appeal process when needed. Provides clinical review and document submission of pre-certification requests for oncology treatment 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 related to daily charge compliance reviews and reconciliation. Collaborates with billing and medical personnel on the resolution of coding issues as required.ACCOUNTABILITIES1. 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.2. 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.3. Reviews and assists with denial management reports as instructed. Identifies and reports any payer trends, denial patterns, and delays to management.4. Communicates with cancer center staff regarding authorization status and decisions as appropriate.5. Participates in process development and improvement as it relates to authorizations, communication, education, etc.6. General understanding of coding for hospital and imaging services recommended, including review of hospital records.7. Thoroughly documents actions taken in appropriate information system(s).8. Additional responsibilities / duties will be assigned based on team workload and competency.9. Completes verification of eligibility and insurance details on cancer center patients including medical oncology, radiation oncology, genetics, and other applicable center services.10. Completes pre-certification / authorization process as needed.11. Performs charge compliance monitoring and submission for all Oncology Revenue generating accounts. Completes charge batch reconciliations. Reviews include : a. Monitors and corrects charges and quantities for oncology procedures (to include but not limited to : acct. number, charge code, etc.)b. Monitors and adjusts patient status changes (e.g. inpatient vs. outpatient)c. Monitors use of series account numbersd. Note : As each patient completes a course of treatment, a full review of charge verification will be done.12. Investigates and resolves finance and central billing office inquiries.a. Researches and addresses department-specific charge issues, audits, etc.b. Responsible for obtaining documentation to justify / clarify charges. Seeks clarification of coding issues with medical personnel through approved communication channels.13. Communicates with cancer center staff regarding eligibility and charge status as appropriate. Report management : a. Reviews and assists with denial management reports as instructed. Identifies and reports any payer trends, denial patterns, and delays to management.b. Creates reports for ProMedica Cancer Institute leadership as requested.14. Maintains current knowledge on medical criteria relating to prior authorization requirements by third-party payers and medical necessity requirements.15. Participates in process development and improvement as it relates to eligibility and charges, communication, education, etc.16. Additional responsibilities / duties will be assigned based on team workload and competency.REQUIRED QUALIFICATIONS1. High School Diploma.2. Demonstrated ability to communicate with medical and administrative staff and patients, understanding levels of care.3. Strong organizational skills and the ability to multi-task.4. Ability to understand directions and communicate and respond to inquiries; requires effective interpersonal and telephone / electronic messaging etiquette skills.5. Intermediate computer knowledge, skills, and proficiency including general office applications.6. Ability to accurately and independently solve problems.7. Ability to manage large volumes of work and quickly learn and retain information regarding issues that present themselves.PREFERRED QUALIFICATIONSAssociate’s degree preferred. Oncology experience preferred. Specific knowledge of medical payers recommended. EPIC electronic health record experience is highly desirable.ADDITIONAL EXPERIENCEPrior oncology eligibility verification and charge compliance duties. Familiarity with ICD10 and CPT codes applicable to services rendered. Experience with electronic record interfaces.Insight is an Equal Opportunity Employer and values workplace diversity.#J-18808-Ljbffr