DCH Health System
Medical Insurance Specialist – DCH Health System
We are looking for a Medical Insurance Specialist to obtain precertifications, authorizations, and referrals from insurance companies for patients receiving care in the Cancer Center. Responsibilities include coordinating with clinicians, clerical staff, and insurance companies to ensure coverage and compliance.
Responsibilities
Obtain precertification, authorization or referral from insurance companies for patients receiving care in the Cancer Center.
Record all precertifications, authorizations, and referrals in the appropriate software system.
Coordinate with clinicians and clerical staff regarding any issues concerning patient insurance status.
Review clinical and non-clinical data, including medical terms, diagnosis or procedure codes for preauthorization or precertification for oncology, hematology, chemotherapy, and radiation treatments.
Utilize comprehensive knowledge of payer policies and criteria related to preauthorization and precertification.
Work with the Financial Navigator/Counselor to educate patients on their health insurance plan, as needed.
Obtain provider referrals from individual PCP, Medicaid, VA and other primary insurances after the initial provider referral by registration.
Make appropriate changes to individual demographics and insurance information on internal systems when needed.
Apply knowledge of CPT codes for procedures/drugs to determine whether precertification is required.
Retrieve daily list of patients’ insurance requirements for chemotherapy support and verify coverage for chemotherapy and radiation treatments.
Verify correct contract and group number in Meditech for preauthorization or precertification.
Confirm facility network status relative to authorization requirements.
Enter preauthorization or precertification numbers into Aria and Expanse.
Communicate with internal and external imaging departments to schedule/precertify imaging for Cancer Center patients.
Communicate with internal pharmacy to follow through on prior authorizations for oncology and hematology medications.
Assist coworkers with tasks to balance workload.
Qualifications
High school graduate.
Minimum of 2 years of oncology experience preferred; healthcare experience required.
Clerical skills with demonstrated proficiency in keyboarding/computer use.
Self‑motivated with ability to work independently.
Excellent interpersonal skills working with public, physicians, insurance companies, and hospital staff.
Ability to read, write legibly, speak, and comprehend English.
Experience with obtaining preauthorization and working with insurance companies preferred.
Knowledge of medical terminology preferred.
Working Conditions
Frequent interaction with others, in person or by telephone, including those that may be discourteous.
Extensive use of computers and computer systems; extensive documentation requirements requiring attention to detail.
Light physical work with minimal force; may lift up to 10 pounds frequently, 20 pounds occasionally.
Physical presence onsite essential.
DCH Standards
Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.
Performs compliance requirements as outlined in the Employee Handbook.
Adheres to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.
Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.
Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.
Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.
Requires use of electronic mail, time and attendance software, learning management software and intranet.
Must adhere to all DCH Health System policies and procedures.
All other duties as assigned.
Seniority level
Entry level
Employment type
Full‑time
Job function
Other
Industries
Hospitals and Health Care
#J-18808-Ljbffr
We are looking for a Medical Insurance Specialist to obtain precertifications, authorizations, and referrals from insurance companies for patients receiving care in the Cancer Center. Responsibilities include coordinating with clinicians, clerical staff, and insurance companies to ensure coverage and compliance.
Responsibilities
Obtain precertification, authorization or referral from insurance companies for patients receiving care in the Cancer Center.
Record all precertifications, authorizations, and referrals in the appropriate software system.
Coordinate with clinicians and clerical staff regarding any issues concerning patient insurance status.
Review clinical and non-clinical data, including medical terms, diagnosis or procedure codes for preauthorization or precertification for oncology, hematology, chemotherapy, and radiation treatments.
Utilize comprehensive knowledge of payer policies and criteria related to preauthorization and precertification.
Work with the Financial Navigator/Counselor to educate patients on their health insurance plan, as needed.
Obtain provider referrals from individual PCP, Medicaid, VA and other primary insurances after the initial provider referral by registration.
Make appropriate changes to individual demographics and insurance information on internal systems when needed.
Apply knowledge of CPT codes for procedures/drugs to determine whether precertification is required.
Retrieve daily list of patients’ insurance requirements for chemotherapy support and verify coverage for chemotherapy and radiation treatments.
Verify correct contract and group number in Meditech for preauthorization or precertification.
Confirm facility network status relative to authorization requirements.
Enter preauthorization or precertification numbers into Aria and Expanse.
Communicate with internal and external imaging departments to schedule/precertify imaging for Cancer Center patients.
Communicate with internal pharmacy to follow through on prior authorizations for oncology and hematology medications.
Assist coworkers with tasks to balance workload.
Qualifications
High school graduate.
Minimum of 2 years of oncology experience preferred; healthcare experience required.
Clerical skills with demonstrated proficiency in keyboarding/computer use.
Self‑motivated with ability to work independently.
Excellent interpersonal skills working with public, physicians, insurance companies, and hospital staff.
Ability to read, write legibly, speak, and comprehend English.
Experience with obtaining preauthorization and working with insurance companies preferred.
Knowledge of medical terminology preferred.
Working Conditions
Frequent interaction with others, in person or by telephone, including those that may be discourteous.
Extensive use of computers and computer systems; extensive documentation requirements requiring attention to detail.
Light physical work with minimal force; may lift up to 10 pounds frequently, 20 pounds occasionally.
Physical presence onsite essential.
DCH Standards
Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.
Performs compliance requirements as outlined in the Employee Handbook.
Adheres to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.
Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.
Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.
Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.
Requires use of electronic mail, time and attendance software, learning management software and intranet.
Must adhere to all DCH Health System policies and procedures.
All other duties as assigned.
Seniority level
Entry level
Employment type
Full‑time
Job function
Other
Industries
Hospitals and Health Care
#J-18808-Ljbffr