Graduate from an accredited school of nursing.
BSN and 2 years clinical experience in an acute care setting is preferred.Job DescriptionJob Summary The Case Manager/Reimbursement Analyst develops and maintains processes to assure that reimbursement for oncology services is accurate and appropriately preauthorized and that loss of reimbursement due to lack of certification prior to service is minimized or eliminated.
This position also insures that every opportunity is explored for patients needing assistance with the cost of drugs for treatment.
This position is an integral part of the oncology team which includes the Oncologist and other physicians, Pharmacist, Nursing Staff, Receptionists, and the Billing Coordinator.
Assists in assessing, developing, implementing, coordinating, monitoring, and evaluating the services required to meet an individual’s health needs while maintaining fiscal integrity.
Serves as a resource to the cancer center team, to address issues with insurance coverage for specific drugs; coordinate orders with schedules; and to assure timely authorization for treatment.
Within this case management interface, acts as a financial manager, problem solver, facilitator, educator and advocate.
Patient population is defined as adult patients and their families.
Qualifications Education: Bachelor of Nursing degree preferred.
Graduate from an accredited school of nursing with current registration in Indiana required.Training: Requires four to six weeks orientation with close supervision for six months to one year.Experience: Two years experience in acute care/critical care nursing.
Previous experience with coding, reimbursement, and Medicare/Medicaid reimbursement issues is preferred.
Independent critical thinking skills.Job knowledge, Skills and Abilities: Excellent communication and organizational skills.
An understanding of reimbursement principles and processes (Medicare, Medicaid, and other third party payers) as well as drug assistance programs.
Familiar with organizational, policies, and procedures of hospital as they relate to the Cancer Center.
Must have the ability to function as an individual as well as be an active member of the Oncology team.
Must have strong skills in developing relationships with various resources and understand the delicate nuances in working with each of them.
Knowledge of computers and related functions.
Completion of basic skills checklist within 60 days.
Verification of competency in basic job knowledge and skills.
Performance Requirements Responsibility for: Reviews daily list of new referrals to the Cancer Center and contacts third parties for precertifications.
Communicates with all patients receiving active chemotherapy to determine insurance status.
Serves as the liaison between the Cancer Center, the patient, and any third party payers.
May be responsible for similar duties related to radiation oncology.
Assists patients with drug assistance programs and available indigent programs.
Attends pharmaceutical representatives visits and stays current with all available assistance through these companies.
Assists in identifying services needed or requested by patients/families and referring to the appropriate resources.
Ability to understand and effectively communicate Medicare and other third party payer billing and data collection compliance requirements.
Assists in the collection of data from patient charts as needed for audit requests.
Surveillance of FDA approval for latest medications and treatments for cancer patients.
Monitoring of billing indicators for patients in clinical trials.
Research issues related to treatment questioned by payers using the National Comprehensive Cancer Network, pharmaceutical company’s and hospital pharmacists.Physical Demands: Walks, sits and stands intermittently.
Must have auditory, visual and verbal skills to review written documents and communicate with nursing staff, Medical Staff and insurance companies via telephone.
Works in office areas and departments which are well-lighted, heated and ventilated.
May come in contact with hazardous health conditions; however, if proper procedure is followed no harm should come to employee.Special Demands: Willingness to work with realization that errors may have serious financial consequences for patients and facility.
Nurses are encouraged to be actively involved in the community as leaders in health and wellness promotion and injury and disease prevention.
Competency, tact, and patience are necessary when communicating with patients, families, physicians, and other personnel.
Develop and implement techniques and/or procedures to meet the needs of physicians, patients and other personnel.
Reflects the mission, philosophy, core values, and customer service plan of Memorial Hospital and Health Care Center in action and attitude.The post Case Manager/Reimbursement Analyst first appeared on Indiana Hire.
Graduate from an accredited school of nursing.