Cancer Services Specialist (Carle Cancer Institute)

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 coordinates all cancer conferences/tumor boards at CCI-Urbana and CCI-Normal. They are responsible for ensuring all standards for CoC and NAPBC accreditations are met; tracking and entering data into the survey portal, coordinating and maintaining regular meetings of cancer committee and subcommittee and taking minutes. Cancer Services specialist play a key role in accreditation survey prep and reporting.

Qualifications:


EDUCATIONAL REQUIREMENTS
Associates preferred.

CERTIFICATION & LICENSURE REQUIREMENTS
none

EXPERIENCE REQUIREMENTS
preferreder 5 years healthcare and/or insurance experience. Knowledge and background of human anatomy, medical terminology and computer skills. Highly organized and ability to function independently

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.
• Assists with generating reports and gathering data for providers and staff in relation to accreditation activities.
• Maintains ongoing cancer conference case lists and distributes to attendees in a timely manner.
• Tracks cancer conference discussion to ensure all required elements are discussed for reporting to American College of Surgeons.
• 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)