Medical Insurance Reviewer

POSITION: Insurance Reviewer

LOCATION: Cincinnati, OH

WEEKLY HOURS: 40

OHC - Specialists in Cancer and Blood disorders, is seeking a full time insurance reviewer to work out of our Wooster Road office in Cincinnati, Ohio. This position will transition to a hybrid/remote schedule after completion of training. As the only independent adult cancer program in the region, we offer Medical, Radiation, Blood and Marrow Transplant, Gynecologic, and Breast Surgical Oncology services. OHC supports a robust cancer research and clinical trials program, neuro-oncology, cancer genetics specialists and supportive care program.

The Insurance Reviewer reviews chemotherapy regimens in accordance to reimbursement guidelines. Obtains necessary pre-certifications and exceptions to ensure no delay in reimbursement of treatments. Researches denied services and alternative resources to pay for treatment.

OHC has been fighting cancer on the front lines for more than 38 years. We are now one of the nation's largest independent oncology practices, as well as the region's premier source of treatment for nearly every form of adult cancer and complex blood disorder. At its heart, our approach to cancer care is simple - to surround our patients with everything they need so they can focus on what matters most: beating cancer!

Why choose OHC?

You take care of our patients, so we take care of you. OHC's benefits include:

• 3 Health Insurance Plans to choose from
• 2 Dental and 2 Vision insurance plans
• A company matched 401K plan
• Profit sharing plan for clinical employees
• Competitive salaries
• Company paid short term / long term disability / life insurance
• Paid Holidays
• A generous PTO plan
• Tuition Reimbursement
• Professional Development Program
• Nationwide Discounts at your favorite hotels, resorts and retailers just for being an OHC employee
• Wellness Program
• Yearly merit raises
• Opportunities for advancement

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• 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. Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patient's records.
• Other duties as requested or assigned.

MINIMUM QUALIFICATIONS:
High school degree or equivalent. Associates degree in Healthcare, LPN state license and registration preferred. Minimum three (3) years medical insurance verification and authorization required.

COMPETENCIES:
-Uses Technical and Functional Experience: Possesses up to date knowledge of the profession and industry; is regarded as an expert in the technical/functional area; accesses and uses other expert resources when appropriate.
-Demonstrates Adaptability: Handles day to day work challenges confidently; is willing and able to adjust to multiple demands, shifting priorities, ambiguity and rapid change; shows resilience inn the face of constraints, frustrations, or adversity; demonstrates flexibility.
-Uses Sound Judgment: Makes timely, cost effective and sound decisions; makes decisions under conditions of uncertainty.
-Shows Work Commitment: Sets high standards of performance; pursues aggressive goals and works efficiently to achieve them.
-Commits to Quality: Emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluated products, processes, and service against those standards; manages quality; improves efficiencies.

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 required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.

WORK ENVIRONMENT:

The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites.