Reviewer

• Review, process, and audit medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence
• Communicate insurance-plan restrictions and special requirements to nursing and medical staff
• Provide feedback to physicians and management regarding pathway documentation and payer issues involving non-covered chemotherapy drugs
• Update coding and payer guidelines for clinical staff
• Track pathways and perform other business office functions as needed
• Obtain insurance authorization and pre-certification for chemotherapy services
• Act as a patient advocate and liaison between patients and payers to answer reimbursement questions and avoid insurance delays
• Research additional or alternative resources for non-covered chemotherapy services to prevent payment denials
• Provide patients with contact lists for community resources, special programs, drugs, pharmaceutical supplies, and financial resources
• Maintain working knowledge of chemotherapy authorization requirements for all payers and applicable regulatory guidelines
• Support and adhere to the US Oncology Compliance Program, including the Code of Ethics and Business Standards
• Perform other duties as requested or assigned

Explore Prior Authorization Reviewer at The US Oncology Network. Review requirements and application details.