Silver Cross Hospital is an extraordinary place to work. We’re known for our culture of excellence and delivery of unrivaled experiences for our patients, their families, the communities we serve…and for each other. Come join us! It’s the way you want to be treated.

Position Summary:  Act as primary charging/coding resource supporting physician revenue capture in Medical Oncology. Perform benefit verification and authorization for medications and Oncology-related diagnostics. Review orders, understand treatment plans, and work with insurer to confirm authorization of high-dollar regimens prior to treatment delivery. Enter inpatient charges. Demonstrate good interpersonal skills with Providers, patients, families, other staff, and outside agencies both in-person and by phone.

Essential Duties and Responsibilities:

• Review work queues to identify patients with treatment plan orders.
• Effectively screen for compliance with payer requirements for medical necessity and precertification.
• Record authorization number and relevant details in Epic in the appropriate location.
• Use screening software to determine whether services being provided meet third-party requirements for payment. Contact physicians as necessary for additional clinical information, initiate Medicare ABN processes as appropriate.
• Explains payer policies and financial responsibility to patients within the revenue cycle to assist in meeting other internal, regulatory and payer requirements.
• Documents financial expectations of payer and medical necessity verification.
• Possess in-depth knowledge of Medicare, Medicaid, PPO, HMO, and other third-party billing requirements.
• Refers appropriately to Patient Financial Services.
• Notifies nursing staff and leadership of any delays / denials in obtaining authorization.
• Assists in appeals as directed by Nurse Manager.
• Facilitates peer-to-peer conversations.
• Enters inpatient Provider charges.
• Serves as a charging/coding resource supporting providers’ revenue capture.
• Review medical documentation for assigning billing modifiers to insurance claims where appropriate and applicable.  Works assigned work ques daily with the goal to complete all assigned tasks.
• Perform charge reconciliation and work with the providers in instances of missing charges/ revenue - ensuring the missing revenue gets posted and realized.
• Maintains current knowledge of all billing and compliance policies, procedures, and regulations through AAPC educational offerings.

Required Qualifications: 

Education and Training:

• High School Graduate or equivalent.
• Coding certification required.
• In-depth knowledge of Medicare, Medicaid, PPO, HMO, and other third-party billing requirements.
• Experience with authorizations and/or Oncology strongly preferred.
• Ability to speak English clearly and fluently.
• Basic computer skills.
• Excellent communication customer service skills required.

Work Shift Details:

Days, Monday-Friday

Department:

CANCER CENTER

Benefits for You

At Silver Cross Hospital, we care about your health and well-being and that is why we work hard to provide quality and affordable benefit options for you and your eligible family members.   

Silver Cross Hospital and Silver Cross Medical Groups offer a comprehensive benefit package available for Full-time and Part-time employees which includes:

·       Medical, Dental and Vision plans

·       Life Insurance

·       Flexible Spending Account

·       Other voluntary benefit plans

·       PTO and Sick time

·       401(k) plan with a match

·       Wellness pr