Use of clinical knowledge for the management of complex James Cancer Center ambulatory medical necessity denials through the appeals process
Job Summary
Use of clinical knowledge for the management of complex James Cancer Center ambulatory medical necessity denials through the appeals process.
Providing scientific evidence to support cutting edge therapies, and diagnostic services.
Submission of pre-determination requests proactively supporting clinicians in efforts to identify areas where loss of revenue is at risk to mitigate that risk.
Matching Summary
Use of clinical knowledge for the management of complex James Cancer Center ambulatory medical necessity denials through the appeals process.
Skills & Requirements
Must-have
clinical knowledge for medical necessity denials
scientific evidence for cutting edge therapies
clinical education to payers
identify trends for clinical education
submission of pre-determination requests
correcting billing errors
Nice-to-have
foster effective working relationships
pursue hospital reimbursement
facilitate education for compliance
Key Requirements
Associate Degree in Nursing preferred
3 years oncology experience preferred
Experience with Windows, Excel, Access
3 years oncology experience required
Experience in physician practice
Knowledge of Medicare and commercial insurance reimbursement