Middlesex Hospital
Radiation Oncology Pre-Authorization Billing Specialist
Middlesex Hospital, Middletown, Connecticut, us, 06457
Position Highlights
Department:
Radiation Therapy Hours:
40.00 per week Shift:
Shift 1 Position Summary
Responsible for working with the staff in Radiation Oncology, including Physicians, Manager, Administrative Assistants, PCT, Radiation Therapists and Nurses in the process of obtaining pre-authorization for patient cancer treatments.
Essential Duties & Responsibilities
Under the direction of the Radiation Oncology Manager:
Ability to navigate through the pre-authorization process utilizing the insurance company websites and online forms primarily, but also engaging with the insurance companies via telephone for certain components of the process as necessary. Ability to communicate well with staff in the Radiation Oncology Department on a day to day basis regarding the status of pending insurance cases. Ability to effectively communicate via telephone with the insurance companies regarding obtaining pre-auth, appeal processes & peer review scheduling. Ability to liaise with the business office regarding any pertinent pre-auth cases and past cases that are pending appeal Interprets a patient's requisition and assigns the correct CPT codes & ICD-10 diagnosis codes to the visits in EPIC/MOSAIQ as appropriate for services provided. Uses all available tools, including software, physician input, and administrative staff knowledge to Provides pertinent Radiation Oncology records to the business office as requested in the appeal of past cases.ensure diagnosis codes assigned are correct and accurately represent patient signs, symptoms, results and do not constitute fraud. Complete all diagnosis coding prior to pre-authorization begins. Recognize/analyze problems and/or all situations out of the ordinary and provide resolution as observed by Management. Develops a thorough understanding of and a practical knowledge base of the proper use of all payor websites to accurately deliver appropriate information to patients regarding coverage and requirements for pre-certification of treatment, verification of benefits and self pay information Ability to learn the department electronic medical record (MOSAIQ) to obtain and document pertinent radiation oncology medical records for insurance company pre-auth process application, and for the business office in the appeal of past cases. Ability to work with the hospital electronic medical record (EPIC) for documenting pre-auth information The ability to adapt to the ever changing requirements of the insurance companies and maintain the administrative component of the process accordingly Adheres to all Core Values (Compassion, Pursue Excellence, Cooperation and Collaboration, Upholds Honesty, and Supports Innovation). Adheres to all Absolutes (Privacy and Confidentiality, Professional Appearance, and Responsibility and Commitment). Other job related duties as assigned. Minimum Qualifications
Associate degree or equivalent experience 3 to 5 years in a hospital or medical office related experience CPT Coding knowledge required ICD10 coding knowledge required
Preferred Qualifications
Typing/keyboard skills, ability to work in a fast paced environment quickly and produce quality work Excellent communication skill (telephone, written and interpersonal) is required Experience in Electronic Medical Record and Third party payor Working knowledge of spreadsheets (google & excel) Insurance pre-authorization & verification knowledge Comprehensive Benefits Offered
Competitive and affordable benefits package Shift Differentials Continuing Education assistance Tuition reimbursement Student Loan relief through Fiducius Quick commute access from I-84, Route 9 and surrounding areas
About Middlesex Health
The Smarter Choice for your Career!
Come join one of Connecticut's Top Workplaces, and a Magnet designated organization! At Middlesex Health, we have a unique combination of award-winning talent, world-class technology, and patient-first care that's making health care better. Through our affiliation with the Mayo Clinic Care Network, Middlesex Health has access to the most advanced medical knowledge and research available.
Department:
Radiation Therapy Hours:
40.00 per week Shift:
Shift 1 Position Summary
Responsible for working with the staff in Radiation Oncology, including Physicians, Manager, Administrative Assistants, PCT, Radiation Therapists and Nurses in the process of obtaining pre-authorization for patient cancer treatments.
Essential Duties & Responsibilities
Under the direction of the Radiation Oncology Manager:
Ability to navigate through the pre-authorization process utilizing the insurance company websites and online forms primarily, but also engaging with the insurance companies via telephone for certain components of the process as necessary. Ability to communicate well with staff in the Radiation Oncology Department on a day to day basis regarding the status of pending insurance cases. Ability to effectively communicate via telephone with the insurance companies regarding obtaining pre-auth, appeal processes & peer review scheduling. Ability to liaise with the business office regarding any pertinent pre-auth cases and past cases that are pending appeal Interprets a patient's requisition and assigns the correct CPT codes & ICD-10 diagnosis codes to the visits in EPIC/MOSAIQ as appropriate for services provided. Uses all available tools, including software, physician input, and administrative staff knowledge to Provides pertinent Radiation Oncology records to the business office as requested in the appeal of past cases.ensure diagnosis codes assigned are correct and accurately represent patient signs, symptoms, results and do not constitute fraud. Complete all diagnosis coding prior to pre-authorization begins. Recognize/analyze problems and/or all situations out of the ordinary and provide resolution as observed by Management. Develops a thorough understanding of and a practical knowledge base of the proper use of all payor websites to accurately deliver appropriate information to patients regarding coverage and requirements for pre-certification of treatment, verification of benefits and self pay information Ability to learn the department electronic medical record (MOSAIQ) to obtain and document pertinent radiation oncology medical records for insurance company pre-auth process application, and for the business office in the appeal of past cases. Ability to work with the hospital electronic medical record (EPIC) for documenting pre-auth information The ability to adapt to the ever changing requirements of the insurance companies and maintain the administrative component of the process accordingly Adheres to all Core Values (Compassion, Pursue Excellence, Cooperation and Collaboration, Upholds Honesty, and Supports Innovation). Adheres to all Absolutes (Privacy and Confidentiality, Professional Appearance, and Responsibility and Commitment). Other job related duties as assigned. Minimum Qualifications
Associate degree or equivalent experience 3 to 5 years in a hospital or medical office related experience CPT Coding knowledge required ICD10 coding knowledge required
Preferred Qualifications
Typing/keyboard skills, ability to work in a fast paced environment quickly and produce quality work Excellent communication skill (telephone, written and interpersonal) is required Experience in Electronic Medical Record and Third party payor Working knowledge of spreadsheets (google & excel) Insurance pre-authorization & verification knowledge Comprehensive Benefits Offered
Competitive and affordable benefits package Shift Differentials Continuing Education assistance Tuition reimbursement Student Loan relief through Fiducius Quick commute access from I-84, Route 9 and surrounding areas
About Middlesex Health
The Smarter Choice for your Career!
Come join one of Connecticut's Top Workplaces, and a Magnet designated organization! At Middlesex Health, we have a unique combination of award-winning talent, world-class technology, and patient-first care that's making health care better. Through our affiliation with the Mayo Clinic Care Network, Middlesex Health has access to the most advanced medical knowledge and research available.