Description

SUMMARY

Support oncology services by performing various insurance related functions. Provide training and support of staff in these areas.

ENTRY REQUIREMENTS

• Associate’s degree in Health Services Administration or Business related field preferred. In lieu of degree, 3 years internal revenue cycle experience will be considered, or one year internal oncology insurance verifier. Minimum productivity requirements, and peer review process are required.
• Successful completion of Medical Terminology course, and Anatomy course is required.
• Knowledge of current third-party payer reimbursement rules required.

Keyboard – Computer Skills:

• 
  Advanced keyboard, mouse, computer and Microsoft Office skills. Must have knowledge to utilize the computer programs listed below.
  • ARIA and ABO
  • Outlook
  • Star
  • Smart Web
  • Power Chart
  • 3M Coding
  • Rev Runner
  • Right Fax
  • Multiple payer websites currently used
  • Multiple prior authorization websites currently used
  • NCCN

Other Entry Requirements:

Subject matter expert in assigned focus area.

Advanced systems aptitude, including proficiency in MS Office.

Exemplary customer relation skills and proven ability to communicate effectively and accurately, verbally and in writing with all levels.

Must be able to work independently and prioritize projects and timelines within a flexible schedule. High level problem resolution is a major component of this position.

Able to operate under frequent stressful conditions due to constantly changing requirements in health care. Understands the process of change and how it affects human behavior.

Knowledge of hospital organization and function(s) preferred.

ORGANIZATION

Under the general supervision of the manager of respective revenue cycle department. May also receive direction from the director over specific service line or hospital system

Must maintain a working relationship with all ancillary departments, physician offices, and their staffs.

SPECIFIC DUTIES

1.Supports the Mission, Vision and Values of Munson Healthcare

2.Embraces and supports the Performance Improvement philosophy of Munson Healthcare.

3.Promotes personal and patient safety.

4.Uses effective customer service/interpersonal skills at all times.

5.Present a team oriented, leadership role, promoting vision, goal oriented direction and creativity within work teams.

6.Exercises a high degree of control over confidential information

7.Solves problems and anticipates peak periods of volume in order to plan workload accordingly. Consults with Manager/Coordinator in matters of staffing and discipline.

8.Documents patient messages/requests in EHR and forwards to appropriate clinical staff/physician.

9.Obtain authorizations for clinical trials, chemotherapy, non chemo injections/infusions, procedures, genetic/molecular diagnostic tests, and radiology services

10.Verify medical necessity for chemotherapy, non chemo injection/infusion, procedures, genetic/molecular diagnostic tests, and radiology services.

11.Collaborate with providers, prepare documents, and communicate effectively for clinical reviews

12.Meets productivity and quality standards

13.Exercises expertise in a specific discipline within the oncology revenue cycle.

14.Submits medical records required by payers, for audits, and processes appeals

15.May facilitate meetings related to area of expertise, preparing agendas and sharing minutes.

16.Acts as a liaison between own area and other departments/teams.

17.Acts as a resource for financial and clinical areas specific to area of expertise.

18.Works various reports

19.Utilizes operation reporting to identify areas of opportunity for improvement.

20.Uses logic, data and reasoning for decision making.

21.Uses process improvement techniques, including LEAN thinking, in daily work process.

22.Works interdepartmentally with others to solve process issues, and educate about oncology services.

23.Determines most effective means of dealing with patients/family, physicians and visitors with varying attitudes and problems.

24.May precept new hires and is responsible for training, but does not have supervisory responsibility.

25.Keeps educational information, manuals and guides at team level updated and current.

26.Performs other duties and responsibilities as assigned.