United States onlyThe Oncology Claims Analyst 2 will coordinate coding audits and educational functions for FMOLHS and the Oncology Service Line, managing drug authorizations, coding work queues, and providing coding and reimbursement feedback for education opportunities identified to the Service Line and FMOLHS.
Requirements
- Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc)
- Expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO)
- Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line
- Works closely with major pharmaceutical companies on new drug treatment guidelines/pathways
- Reports findings to Director of Pharmacy and VP of Oncology Service Line
- Advises the executive team on best practices for drug purchase opportunities
- Works with various national oncology specific institutions to manage proper clean claims and decrease likelihood of claim denial
- Conducts high level audits for coding based on specialty service lines
- Assists Management with evaluation of processes to determine opportunities to improve the efficiency and quality of coding and maximum reimbursement avenues
- Implements innovated ideas and process changes
- Conducts and organizes provider peer reviews, physician queries
- Supports the education of pharmacy, registered nursing, physicians, mid-levels, administration, etc on coding and documentation needs
- Assist with quality measures needed for clinic and hospital based department success with national certifying bodies
- Ensures financial success as subject matter expert on NCCN guidelines/government payer requirements
- Proactively researches and understands payer issues
- Troubleshoots and resolves issues that impact revenue
- Works collectively with FMOLHS denial management team to audit Medicare, Medicaid, and Insurance claims for accurate coding, charging, and modifier usage
- Monitors and evaluates compliance with documentation standards to identify trends, issues, risk areas, and opportunities for performance improvement
- Continually analyzes reports/margin analyzers to communicate business performance
- Acts as a liaison for Professional Billing and FMOLHS Central Billing Office Management
Benefits
- Paid Time Off
- 401k Matching
- Retirement Plan
- Visa Sponsorship
- Four Day Work Week
- Generous Parental Leave
- Tuition Reimbursement
- Relocation Assistance
