Alliance Cancer Specialists, the largest community-based oncology practice in Southeastern PA, is seeking a Pre-certification Specialist for our Feasterville business office. The ideal candidate will be a detail-oriented individual who is able to communicate effectively with various stakeholders.

Top Reasons To Work for Alliance Cancer Specialists:

• Comprehensive benefits package for full-time employees including:

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• Medical, Dental, Vision, Life, and Disability insurance
• 401k Plan
• 401k Match
• Paid Time Off

• One on one mentoring and training with our skilled and experienced medical office team that will allow you to expand your skill set
• Highly competitive pay

• Day shift only. No evenings.
• No weekends or major holidays.

Responsibilities:

• Reviews, processes, and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen and pathway adherence.
• Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
• Obtains insurance authorization and pre-certification for chemotherapy services. Researches additional or alternative resources for non-covered services to prevent payment denials. Provides a contact list for patients community resources including special programs, drugs and pharmaceutical supplies and financial resources.
• 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.
• Prepares and submits write-off requests with appropriate documentation.
• Processes insurance/patient correspondence, including denial follow-up. Maintains reimbursement correspondence and filing systems. Reviews and processes adjustments and refund requests. Assists with review of financial disclosures and negotiated agreement adjustments. Provides coverage for Patient Financial Counselors. Reports any problems, issues or payer trends.
• Maintains a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization. Complies with patient confidentiality laws and regulations.
• Updates coding/payer guidelines for clinical staff. Tracks pathways and performs various other business office functions on an as needed basis.

• Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards.

Qualifications:

• High school degree or equivalent, required.
• At least 2 years of experience in medical insurance verification and authorization, required.
• Billing and coding experience, preferred.
• Ability to provide pleasant, friendly phone skills, required.
• Ability to handle multiple tasks in a fast-paced environment, required.

Work Environment:

This position is 100% on-site. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work is performed in an office environment and involves frequent interaction with patients, clinical and business office staff and payers.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is occasionally required to stand, walk, and reach with hands and arms. The employee must occasionally lift and/or move up to 30 pounds. Requires vision and hearing corrected to normal ranges.

Job Type: Full-time

Pay: From $18.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

Ability to commute/relocate:

• Feasterville Trevose, PA 19053: Reliably commute or planning to relocate before starting work (Required)

Education:

• High school or equivalent (Required)

Experience:

• Insurance verification: 1 year (Required)
• Medical coding: 1 year (Required)

Work Location: One location

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