Washington University is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity or expression, national origin, genetic information, disability, or protected veteran status.
This position is full-time and works approximately 40 hours per week.
Department Name/Job Location:
This position is in the Department of Medicine, Division of Medical Oncology. This position is for the Medical School Campus.
Position performs varied professional services to ensure Treatment room drug/services are reviewed, appropriate and approved for insurance/payment coverage. This is performed in an efficient manner that reimbursement is maximized through required interaction with third-party payers or other financial means.
PRIMARY DUTIES AND RESPONSIBILITIES:
Works treatment room HB Alerts and Medical Team Tasks minimally 3 days before patient is scheduled for treatment. Assists as needed with South County, West County, St Peters and any future WU Siteman Treatment infusion site(s). Verifies that an authorization/referral is in approved and in place with any primary/secondary insurance for drug/services that patient is receiving and that we can buy and bill the drug provided.
Drug is not expected to be white/brown bagged by the insurance companies Specialty Pharmacy.
Works closely with Medical team
Timely communicates by task to the physician/medical team regarding any clarification of drug orders or diagnosis complications (off-label) minimally 3 days before patient is scheduled to receive drug/treatment room services to ensure timely calling to insurance and proper authorization/referral approval for services in place before the patient arrives for the appointment. Coordinates and pursues insurance approval of any off-label drug to include medical team letter of medical necessity, peer articles, supporting documents to insurance and work with Supervisor to coordinate and achieve peer to peer for insurance approval. Coordinates drug replacement for off-label when available by drug mfg and when insurance denies peer to peer.
Reviews and screens ordered drugs for patients with insurance benefit check information for possible co-pay assistance program consideration and communicates to Onc Billing Team and/or Front Desk this awareness to coordinate drug assistance enrollment with patient. Notifies Social Worker of any maxed benefit, cobra or other insurance coverage complications identified when reviewing the Benefit Sheet re: issues that would cause financial distress to our patient.
Recognize and proactively communicate to physician/medical team/Onc Billing Team regarding non-contracted insurance plans. Assist with coordination to WUSM Contracting when a Single Payer Arrangement (SPA) may be pursued when a patient is receiving a unique service by our providers (clinical trial or stem cell transplant). Assist patient by working with medical team to coordinate care with an in-network provider for transferring services.
Works to scrub fee tickets, scan in documents, review treatment chart for new drug or regimen to ensure an auth in place, reviews insurance in Allscripts /Computer software to ensure insurance was not updated and the auth we have is for the old insurance-not the new insurance, along with other miscellaneous office duties.
Timely completes any new tasks, projects or assignments as directed by Supervisor/Manager.
High school diploma.
3 to 5 years of experience in a medical office setting.
Some college or Associate degree.
RHIT and/or CPC certification, coding experience.
Excellent communication, interpersonal, and organizational skills requires; experience interacting with managed care plans, insurance companies, and third-party payers; ability to work with internal and external customers, including physicians, nurses, patients, and families.
The hiring range for this position is $18.81 - $23.52 per hour.
All external candidates receiving an offer for employment will be required to submit to pre-employment screening for this position. Current employees applying for a new position within the university may be subject to this requirement. The screenings will include a criminal background check and, as applicable for the position, other background checks, drug screen, employment and education or licensure/certification verification, physical examination, certain vaccinations and/or governmental registry checks. All offers are contingent upon successful completion of required screening.
Please attach a copy of your most current signed performance evaluation (completed within the last 18 months) to your online account. If you have not received a performance evaluation, you may provide two current signed letters of recommendation (written within the last 18 months), preferably to include one letter from either a current or recent former supervisor. To attach these documents, go to: My Career Tools, Add Attachment, Attachment Type – Performance Reviews or Letters of Recommendation.
Washington University in St. Louis, a medium-sized, independent university, is dedicated to challenging its faculty and students alike to seek new knowledge and greater understanding of an ever-changing, multicultural world. The University offers more than 90 programs and almost 1,500 courses leading to bachelor's, master's and doctoral degrees in a broad spectrum of traditional and interdisciplinary fields, with additional opportunities for minor concentrations and individualized programs. The faculty is composed of scholars, scientists, artists and members of the learned professions. They serve society by teaching; by adding to the store of human art, creativity, understanding, and wisdom; and by providing direct services, such as health care.