Georgia
California
Durham, North Carolina
United States - Nationwide
Saint Louis, Missouri
Posted: 25-Sep-24
Location: Los Angeles, California
Salary: Open
Categories:
Internal Number: 142816440
Under the direct supervision of the Revenue Integrity Specialist Manager, the Reimbursement Specialist Supervisor will assist with the direct support to the staff, physicians, hematology/oncology patients, and the development and implementation of action plans for research related denial management and prevention. The incumbent will optimize research authorizations and reimbursement by being the direct supervisor and point of contact for research authorizations coordinator, clinic and research related patient billing questions, free drug patient assistance, billing questions and assisting with charge review work queue edit corrections. The incumbent will assist the Manager with conducting comprehensive analysis of patient benefits and coverage to ensure timely and appropriate reimbursements and will work with the hematology/oncology authorizations manager on medical necessity reviews and tracking denials. Other major duties include but are not limited to: supervising a team of leads and administrative assistants, act as a back up to the manager with troubleshooting and resolving operational issues, assist with the selections and direct oversite of the administrative staff members, providing support to leads and administrative assistants in other oncology community practices, arranging coverage, facilitating communication with referring providers, and provide follow-up through telephone and EPIC systems.
Salary range: $30.56/hr - $60.82/hr
Required:
- Knowledge of oncology CPT and ICD-10 codes and medical office procedures. General knowledge of oncology procedures and terminology.
- Working knowledge of insurance authorizations and verification process for major medical insurance plans.
- Healthcare research and analysis skills sufficient to support drug coverage and reimbursement.
- Experience with varied computer software and hardware including knowledge of Microsoft Word, Excel and Outlook, CareConnect, billing systems and the internet.
- Possess strong customer service skills to promote pleasant and effective interactions with patients, staff and physicians.
- Skills in analyzing information, problems, situations, practices and procedures to recognize alternatives and provide solutions while maintaining cooperative working relationships with administrators, physicians, peers and the public.
- Ability to work as part of a team, maintaining confidentiality in all assignments and show initiative in identifying and solving problems as they occur.
- Ability to set priorities and complete assignments in a timely manner under minimal supervision.
- Advanced organizational skills to ensure a workable, efficient workspace and accomplish established objectives.
- Skills in adapting to and implementing frequently changing procedures.
- Knowledge of State and Federal programs to ensure reimbursement from Medicare, Medi-Cal, or other sponsoring agencies as well ask knowledge of reimbursement guidelines for commercial and managed care payers.
- Skill in recognizing a high priority situation and taking appropriate and immediate action.
- Ability to maintain composure when confronted with difficult situations and respond professionally.
- Ability to make independent judgements and to evaluate complex, sensitive issues with diplomacy
- Skill in speaking clearly and using appropriate grammar.
- Skill in writing concise, grammatically correct reports/correspondence.
- Ability to perform basic mathematical functions.
- Working knowledge of medical terminology to sufficiently identify various procedures to obtain optimum benefit information and reimbursement.
- Working knowledge of third party payor verification terminology.
- Knowledge in the functional operations of third party payors and utilization review agencies to expeditiously coordinate follow-up.
- Interpersonal skills to interact with all members of the healthcare team to develop and maintain a cooperative working environment.
- Ability to set priorities and complete assignments in a timely manner.
- Ability to evaluate situations and appraise supervisor of all exceptional and non-standard activities upon occurrence.
- Demonstrated ability to be punctual and maintain a satisfactory attendance record.
- Demonstrated ability to adhere to departmental policies and procedures and work rules.
- Ability to perform other tasks and duties as assigned.
- An understanding of the healthcare industry, including both commercial and government payer landscape, utilize critical thinking to problem-solve challenges, including empathetic listening.
- Skills in order to interact effectively with patients and providers.
Preferred:
- Minimum of 2 years authorizations and billing experience
- Minimum of 1 year of experience with copayment assistance programs
