Insurance Reviewer - Clinical

Comprehensive Cancer Centers of Nevada has an exciting opportunity for a full time Insurance Reviewer-Clinical in our Central Business Office in the Las Vegas area. Scope

•      Under general supervision, reviews chemotherapy regimens, radiotherapy treatment requests and diagnostic imaging requests in accordance with reimbursement guidelines

•      Obtains necessary pre-certifications and exceptions to ensure no delay in reimbursement of treatments

Essential Duties and Responsibilities

•       Reviews, processes and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence

•       Reviews, processes and audits the medical necessity for each radiotherapy treatment request and diagnostic imaging request

•       Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans

•          Provides prompt feedback to physicians and management regarding pathway documentation issues and payor issues with non-covered chemotherapy drugs

•       Updates coding/payor guidelines for clinical staff

•          Tracks pathways and performs various other business office functions on an as needed basis

•       Obtains insurance authorization and pre-certification specifically for chemotherapy services, radiotherapy services and diagnostic imaging

•          Works as a patient advocate and functions as a liaison between the patient and payor to answer reimbursement questions and avoid insurance delays

•       Maintains a good working knowledge of chemotherapy authorization requirements for all payors and state and federal regulatory guidelines for coverage and authorization

•       Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regard to patient records

•       Performs other duties as requested or assigned