THIS IS AN ON SITE POSITION - REMOTE WORK IS NOT OFFERED-Under general supervision, reviews patient records in accordance to reimbursement guidelines. -Obtains necessary pre-certifications and exceptions to ensure no delay in reimbursement of treatments.-Researches denied services and alternative resources to pay for treatment.Essential Duties and Responsibilities -Reviews, processes and audits the medical necessity for each patient relative to pathway adherence.-Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with insurance plans. -Provides prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered needs.-Updates coding/payer guidelines for clinical staff. -Tracks pathways and performs various other business office functions on an as needed basis-Obtains insurance authorization and pre-certification -Researches additional or alternative resources for non-covered chemotherapy services to prevent payment denials.-Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patients records.-Other duties as requested or assigned.About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
