Treatment Analyst Position Available In Fulton, Georgia

Treatment Analyst 3.8 3.8 out of 5 stars 1800 Peachtree St NW, Atlanta, GA 30309 Welcome to Piedmont Cancer Institute – not just a workplace, but a partner in patient care. Piedmont Cancer Institute (“PCI”) has served patients in the Atlanta area for over 36 years. We currently have 20 APPs and 17 physicians and 5 locations serving the greater Atlanta area and we are growing. At PCI, we strive to deliver the best possible comprehensive patient care, using leading-edge cancer therapies, dedication to excellence and compassion in care. Regardless of your profession, you will find more than a job at PCI. You will find a meaningful career. Why Join Us? We are looking for talented and highly-motivated individuals who demonstrate a natural desire to support the meaningful work of community oncologists and the patients we serve.

Job Description:

The Treatment Analyst representative works with insurance companies to authorize various treatment services including chemotherapy, infusions, and injectables. The Treatment Analyst demonstrates a high level of accountability to ensure accurate selection of insurance, documentation of benefits coverage, and submission of necessary preauthorization to ensure no delay in reimbursement of treatment. The successful candidate will be flexible and be able to multi-task in a fast-paced, high-volume setting. Our ideal candidate has a fundamental understanding of how insurance verification and precertification impacts the revenue cycle as well as PCI patients. Previous insurance verification and prior authorization experience is crucial for success in this role, experience in oncology preferred. This position is located at our Central Business Office in Atlanta and reports to the Treatment Analyst Supervisor. Primary Job Function Contacts insurance companies to determine preauthorization requirements for all chemotherapy, injectables, infusions or other treatments – including OPI treatment. Reviews and submits clinical information to support medical necessity for treatment, verifying the completeness and accuracy of all information before submission. Calls insurance companies or uses online tools to obtain preauthorization prior to service date. Follows-up timely and thoroughly. Utilize reports to initiate preauthorization on treatment and ensure authorization is in place at least 48 hours prior to the scheduled treatment. Ensures authorization details for all treatment services are documented in the patient’s record and within the Business Office link of OncoEMR. Review chemotherapy/treatment regimens in accordance to reimbursement and medical necessity guidelines. Provides feedback to IVR/Treatment Analysis supervisor regarding documentation issues and payer issues with non-covered chemotherapy drugs. Coordinate with clinic staff to inform them of any restrictions or special requirements regarding specific insurance plans. Coordinate with front office staff and IVR to ensure accurate insurance information is submitted and verified before all treatments. Confirm that verification details for all treatment is documented in the patient’s record. Acts as liaison between clinical staff, patients, IVR and insurance by informing all parties of coverage or precertification issues, including answering questions, helping, and relaying messages pertaining to verification and precertification. Has and maintains an advanced knowledge of authorization requirements for all payers including State and Federal regulations for coverage and authorization. Multi-task and use time efficiently; perform professionally at a high level under tight deadlines and in a fast paced ever-evolving work environment, successfully prioritize, and adapt to changing demands. Identify problems or trending issues, provide suggestions for findings, and to determine solutions. Communicate issues to management, including payer, system or escalated account issues. Respond timely to emails and telephone messages as appropriate. Regularly meet with IVR/Treatment Analysis Supervisor to discuss and resolve verification issues or preauthorization obstacles. Regularly attend weekly/monthly department meetings. Regularly attend monthly Revenue Cycle Department meetings. Other duties as assigned. Abide by Health Insurance Portability and Accountability Act (HIPAA) when handling any and all protected health information (PHI). Qualifications High school diploma (or equivalent) is required. Collegiate education preferred. Three + years of medical office experience is preferred with demonstrated skills in problem solving, attention to detail, ability to learn and use multiple systems and effective written and verbal communication skills Advanced technical skills including PC and MS Outlook Advanced knowledge of health insurance benefits including copay, deductible, co-insurance for In-network & out-of-network services Advanced Knowledge of Precertification including infusion, injectables and other forms of chemotherapy Advanced knowledge of CPT, HCPCs, and ICD-10 codes Advanced knowledge of medical terminology and business office processes Hematology/Oncology experience strongly preferred, however, not required Strong interpersonal skills Customer service experience and the ability to prioritize, work accurately, work well independently and able to maintain focus under pressure Must be able to sit 8 hours/day and work through occasional high stress situations. Exposed to general indoor working conditions Key Performance Indicators Denial rate – percentage of total claims denied due to inaccurate information inputted during verification/preauthorization < 3% Preauthorization completed with-in three-five business days before date of service Precertification performance score of 94%