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Insurance Reviewer

Flower Mound, TX

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RemX Staffing is looking for a Clinical Insurance Reviewer for a client in Flower Mound, TX!

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

  • 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 payer issues with non-covered chemotherapy drugs.
  • Updates coding/payer 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. Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
  • Researches additional or alternative resources for non-covered chemotherapy services to prevent payment denials. Provides a contact list for patients community resources including special programs, drugs and pharmaceutical supplies and financial resources.
  • Maintains a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization.

Hours: Monday through Friday 8:30AM - 5PM

Pay: $18.00 - $20.00 DOE

Paid weekly with benefits!!

**This is a 2 month contract to hire position.**

Job Requirements

  • High school diploma or equivalent required
  • Medical Office/Insurance experience required

Interested? Apply now! 

Apply Now