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Posted : Wednesday, August 28, 2024 12:26 PM
Department: Cancer Institute - CPG_10_48
Entity: Champaign-Urbana Service Area
Job Category: Clerical/Admin
Employment Type: Full - Time
Job ID: 37712
Experience Required: 1 - 3 Years
Education Required: Not Indicated
Shift: Day
Location: Urbana, IL
Usual Schedule: M-F, 8a-5p
On Call Requirements: None
Work Location: Carle Cancer Institute
Weekend Requirements: None
Holiday Requirements: None
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 assists with identifying, registering and maintaining records of all cancer patients by utilizing the tumor registry data system.
Analyzes registry data; coordinates cancer registry activities and is responsible for the administrative organization and presentation of cancer registry activities including cancer conferences, survey preparation and reporting Qualifications: EDUCATIONAL REQUIREMENTS Associates preferred.
CERTIFICATION & LICENSURE REQUIREMENTS none EXPERIENCE REQUIREMENTS 5 years healthcare and/or insurance experience.
Knowledge and background of human anatomy, medical terminology and computer skills.
SKILLS AND KNOWLEDGE Medical 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.
Prepares and monitors physician chart audits for completeness Maintains Eligibility Requirements and Commission on Cancer Standards, Survey Application Record and the Facility Information Profile System.
Maintains the Cancer Registry Policy and Procedure Manual.
Provide clerical support for administrative and general office duties.
Assists in achieving and maintaining the Certification of Accreditation from the American College of Surgeons/Commission on Cancer and the National Accreditation Program for Breast Centers for survey.
Completes data requests for physicians and staff upon request.
Organizes, prepares and completes the Annual Report for publication.
Attends cancer related educational activities.
Ensures Cancer Registry's software is updated with the essential updates.
Tracks all cancer and required non-malignant cases for survivorship program.
Ensures meeting minutes are complete and cancer committee documentation meets all standards for accreditation.
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: human.
resources@carle.
com.
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.
Understands payment denials and how to prevent denials to reduce losses; works and appropriately appeals the denials from insurance companies.
The Cancer Services Specialist assists with identifying, registering and maintaining records of all cancer patients by utilizing the tumor registry data system.
Analyzes registry data; coordinates cancer registry activities and is responsible for the administrative organization and presentation of cancer registry activities including cancer conferences, survey preparation and reporting Qualifications: EDUCATIONAL REQUIREMENTS Associates preferred.
CERTIFICATION & LICENSURE REQUIREMENTS none EXPERIENCE REQUIREMENTS 5 years healthcare and/or insurance experience.
Knowledge and background of human anatomy, medical terminology and computer skills.
SKILLS AND KNOWLEDGE Medical 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.
Prepares and monitors physician chart audits for completeness Maintains Eligibility Requirements and Commission on Cancer Standards, Survey Application Record and the Facility Information Profile System.
Maintains the Cancer Registry Policy and Procedure Manual.
Provide clerical support for administrative and general office duties.
Assists in achieving and maintaining the Certification of Accreditation from the American College of Surgeons/Commission on Cancer and the National Accreditation Program for Breast Centers for survey.
Completes data requests for physicians and staff upon request.
Organizes, prepares and completes the Annual Report for publication.
Attends cancer related educational activities.
Ensures Cancer Registry's software is updated with the essential updates.
Tracks all cancer and required non-malignant cases for survivorship program.
Ensures meeting minutes are complete and cancer committee documentation meets all standards for accreditation.
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: human.
resources@carle.
com.
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.
• Phone : NA
• Location : Urbana, IL
• Post ID: 9002637956
