XTN-2ECE992 | CLINICAL-TEAM MEMBER

Duties and responsibilities

• Contact insurance carriers to verify patient’s insurance eligibility, benefits and requirements.
• Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services.
• Review, request, follow up and secure authorizations for high dollar cost oncology chemotherapy drugs.
• Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
• Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
• Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial.
• Prioritize the incoming authorizations by level of urgency to the patient.
• Manage correspondence with insurance companies, physicians, specialists, and patients as needed, including documenting in the EHR as appropriate.
• Respond to clinical questions regarding payer medical policy guidelines.

Minimum competencies

• Excellent written and spoken English
• Unflinching integrity and personal work ethics
• Self-starter who strives for self and team excellence
• Flair for client satisfaction
• Attention to detail and concern for accuracy
• Excellent time management skills and multi-tasking ability
• Excellent team player
• Compliant to rules and regulations

Minimum qualifications

• Academic qualification for this role is a graduate in Nursing.
• Required Certifications/Licensure: Registered Nurse currently licensed.
• Familiarity with health compliances, such as
  Awareness and implementation of ISO, ISMS and GRIC policies
  Adherence to the rules and regulations as outlined by the management.