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.**