Carle
Location
Urbana, IL | United States
Job description
Cancer Services Specialist (Carle Cancer Institute)
Department: Cancer Institute - CPG_10_19
Entity: Champaign-Urbana Service Area
Job Category:
Employment Type: Full - Time
Job ID: 40318
Experience Required: 3 - 5 Years
Education Required: Not Indicated
Shift: Day
Location: Urbana, IL
Usual Schedule: Monday-Friday
On Call Requirements: No
Work Location: Carle Cancer Institute
Weekend Requirements: No
Holiday Requirements: No
Email a Friend Save Save Apply Now
Position Summary:
The Cancer Services Specialists is responsible for all the pre-authorizations and insurance inquiries within the cancer center. Understands payment denials and how to prevent denials to reduce losses; works and appropriately appeals the denials from insurance companies. The Cancer Services Specialist coordinates all cancer conferences/tumor boards at CCI-Urbana and CCI-Normal. They are responsible for ensuring all standards for CoC and NAPBC accreditations are met; tracking and entering data into the survey portal, coordinating and maintaining regular meetings of cancer committee and subcommittee and taking minutes. Cancer Services specialist play a key role in accreditation survey prep and reporting.
Qualifications:
EDUCATIONAL REQUIREMENTSAssociates preferred.CERTIFICATION & LICENSURE REQUIREMENTSnoneEXPERIENCE REQUIREMENTSpreferreder 5 years healthcare and/or insurance experience. Knowledge and background of human anatomy, medical terminology and computer skills. Highly organized and ability to function independentlySKILLS AND KNOWLEDGEMedical terminology and/or office skills very important. Communication skills and attention to detail is important. Typing and telephone skills. Proficiency with computers and programs such as PowerPoint, Word, Excel. Demonstrates knowledge of insurance regulations. Displays, reviews, and interprets a broad understanding of third-party payer regulations related to reimbursement issues Works in a timely and accurate manner to ensure appropriate reimbursement and claims appeals Makes appropriate independent decisions that may have a financial impact on the institution and the patient in accordance to policies and resources Understands payment denials and how to prevent denials to reduce losses to the hospital Comfortable with insurance regulations Knowledge in CPT and ICD 9 (10) nomenclature.
Essential Functions:
Assumes primary responsibility in working with the third party payer for screening and authorizations for appropriate criteria/pre-certs/third party approvals
Obtains, documents, verifies and conducts follow-up on insurance authorizations and insurance eligibility as required for scheduled exams
Checks insurance eligibility to ensure that the information provided matches the insurance carrier's database information
Prepares written communication to notify appropriate staff of authorization updates and/or changes for insurance carriers
Interacts with external customers to inform and educate regarding authorization procedures
Manages and resolves denied cases. In cooperation with Billing Department, works denials by sending appeal letters and making appropriate contact with insurance companies or billing staff
Generates timely and compliant denial letters and to facilitate the submission of appropriate appeal documentation
Provides recommendations for policy and procedure changes to management to prevent or limit denials
Reviews and ensures diagnostic, ICD-10, and CPT code is utilized for ordering and pre-authorizations
Schedules, prepares, and coordinates Administrative Cancer Committee Meetings, cancer conferences, and meetings.
Assists with generating reports and gathering data for providers and staff in relation to accreditation activities.
Maintains ongoing cancer conference case lists and distributes to attendees in a timely manner.
Tracks cancer conference discussion to ensure all required elements are discussed for reporting to American College of Surgeons.
Competent in at least two (2) claims areas (Diagnostics, Oral Chemo, Infusion, or Radiation) or
Competent in at least two (2) cancer registry tasks (SAR/PAR completion, Tumor Board Schedule, Prep and Notes, CoC/NAPBC Scheduling, Prep, Notes, or Suvivorship Tracking)
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: [email protected].
Effective September 20, 2021, the COVID 19 vaccine is required for all new Carle Health team members. Requests for medical or religious exemption will be permitted.
Job tags
Salary
