Submit chemotherapy/specialty drug prior approvals via telephone, on-line or via insurance company forms. Gather pertinent clinical records to support medical necessity.
Evaluate appropriateness of treatments by comparing drugs/disease against industry criteria such as FDA labeling, NCCN and CMS guidelines.
Prioritize follow-up and completion of multiple in-process authorizations. Maintain spreadsheet tools for expiring authorizations.
Document decision making and/or authorization #’s in several computer systems. Maintain accurate documentation of authorizations in infusion accounts. Update patient insurance changes on infusion accounts, per procedures.
Notify manager, physician and servicing department of possible delay of service for any infusions which have not been approved prior to the date of service.
Respond to patient billing inquiries. Direct patient to PFS, or coordinate directly with PFS for further handling.
Counsel patients regarding insurance benefits. Explain financial responsibilities for treatments, payment options and collection procedures to patients or parties responsible for payment.
Advise and help solve patient health insurance eligibility issues. Contact insurance carriers or other sources and act as an advocate for the patient.
Identify financial assistance programs for patients unable to meet their financial obligations. Provide assistance to uninsured patients and families in completing and filing Medicaid or assistance program applications with the appropriate agency.
Strategize solutions for obstacles to care. Apply for free drug for off-label/compassionate care use.
Process claims and payments for financial advocacy program.
Participate in solving payment denials for infusion therapies.
Perform all other duties and projects as assigned.
High school diploma is required
Ability to multi-task and navigate between multiple computer systems simultaneously, resource tools and websites
Strong communication and customer service experience
Strong organizational skills and attention to detail
Capacity to learn and retain knowledge on chemotherapy/specialty drugs, including J-codes, dual nomenclature for pharmaceuticals and become familiar with varying processes of insurance companies
5 years of medical office experience
Ambulatory, Oncology background a plus
ICD-10/CPT coding, medical terminology and medical billing experience preferred
Previous experience as a financial counselor or background in health insurance preferred
Understanding of medical insurance processing, and State and Federal assistance programs
Ability to use multiple resource tools and websites
See, read, and/or operate computers, telephones, office equipment, documents, labels, including manipulating paper requiring the ability to move fingers and hands.
Remain sitting, standing, or walking for long periods of time to perform work on a computer, telephone, or other equipment.
Frequent interactions with associates, patient care providers, patients, and visitors that require associate to verbally communicate as well as hear and understand spoken information, alarms, needs, and issues quickly and accurately, particularly during emergency situations.
Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use and typing for documenting patient care, accessing needed information banding patients, etc.
Need to walk and assist with transporting/ambulating patients and obtaining and distributing supplies and equipment. This includes pushing/pulling gurneys and portable equipment, including heavy items (over 50 lbs.).
Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests.
Our associates are given valuable opportunities to contribute, to innovate and create meaningful work that makes an impact in the communities we serve around the world. We also offer a culture of excellence that drives customer success and improves patient care. We believe in giving back to the community and offer a competitive benefits package. To learn more, visit: r1rcm.com.
R1 RCM Inc. (“the Company”) is committed to the principles of equal employment opportunity. The Company’s practices and employment decisions, including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is committed to providing a workplace free from harassment based on any of the foregoing protected categories.
If you are an individual with a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.