insurance coordinator

Overview

SCOPE: Coordinates and/or reschedules patient appointments and services as necessary. Coordinates and communicates all patient insurance and payment information. Updates and disseminates all clinical supportive data to appropriate staff to maximize reimbursement and avoid insurance delays. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards. ESSENTIAL DUTIES AND RESPONSIBILITIES: -Reviews the medical necessity for each patient activity and service, including radiological and specialty referrals and daily hospital admissions for appropriateness. Reschedules appointments as necessary. -Obtains insurance authorization and pre-certification for services. -Works to prevent payment denials and delays though understanding of payment plans and contracts for patient services involving clinical pathways. -Works as a patient advocate and functions as a liaison between the patient and payor to answer insurance related questions. Updates and disseminates all clinical supportive data to maximize reimbursement and avoid insurance delays. Researches additional or alternative resources for non-covered services. -Provides clinical updates to payors and promptly communicates appropriate information prior to patient insurance reviews. -Provides clinical and financial information to patients to assist with insurance and payment coordination. Clarifies clinical policies and procedures and medical records information to non-medical staff. Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans. -As necessary, assists patients with community resources including special programs, drugs and pharmaceutical supplies and financial resources. MINIMUM QUALIFICATIONS: High school graduate or equivalent required. Graduate from an accredited school for vocational or practical nursing. Minimum of three to five years experience as an LVN/LPN in a hospital or clinic setting. Experience in medical insurance and business office activities. Valid state license as LVN/LPN. 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 regularly required to sit and use hands to finger, handle, or feel. The employee is occasionally required to stand, walk, and reach with hands and arms. The employee must occasionally lift and/or move up to 30 pounds. Requires vision and hearing corrected to normal ranges. WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work is performed in an office environment and involves frequent interaction with patients, clinical and business office staff and payors.