Outpatient CDI Infusion Specialist Catholic Health System - 3.5 Buffalo, NY Job Details Full-time $68,972 - $103,448 a year 1 day ago Qualifications Overseeing health insurance pre-certification Clinical documentation improvement

Full Job Description Facility:

Administrative Regional Training Cntr Shift:

Shift 1

Status:

Full Time FTE:

1.000000

Bargaining Unit:

ACE Associates Exempt from

Overtime:

Exempt:

Yes Work Schedule:

Days Hours:

7-4, 8-4 flexible

Summary:

Under the direction of the Manager Revenue Integrity, including oversight from System revenue cycle leadership, Outpatient Clinical Documentation Improvement Specialist ("OP CDS") is responsible for securing insurance authorizations for complex infusions therapies that include, but not limited to oncology, chemotherapy, and biologic. This role requires specialized knowledge of oncology treatment regimens, payer requirements, and high-cost specialty medications to ensure timely access to care and accurate reimbursement. This position partners closely with providers, pharmacy, revenue integrity, scheduling, prior authorization and billing teams to ensure all authorization requirements are met prior to treatment. The specialist plays a critical role in minimizing denials, identifying payer trends, and supporting compliant efficient workflows across the revenue cycle. The Outpatient Clinical Documentation Improvement Specialist ("OP CDS") is responsible for activities which improve the accuracy of facility outpatient clinical documentation and charging including education with the clinical departments and root cause correction to support accurate charging and coding in compliance with Hospital/Health System policies related to infusions. The OP CDS assists clinical areas to effectively document services and understand the relationship of documentation, medical necessity, and charging for the services provided in accordance with Hospital/Health System policies and procedures. This position supports a multi-facility health system, and as such, requires the ability to travel to various Catholic Health facilities throughout the Health System.

Responsibilities:

EDUCATION

Bachelor's degree or over five (5) years of related healthcare experience in lieu of degree Certified Medical Assistant (CMA), Registered Medical Assistant (RMA), or the following credentials RN, LPN, RHIA, RHIT, CPC, COC, or CDEO required

EXPERIENCE

Minimum of 2-4 years of prior authorization experience in oncology, infusion services, or specialty medications Strong preference for experience with chemotherapy regimens, infusion scheduling, or oncology workflows Experience working with Epic, preferred

KNOWLEDGE, SKILL AND ABILITY

Strong understanding of oncology/infusion therapies and complex medication regimens Knowledge of payer authorization requirements, medical necessity criteria, and reimbursement structures Familiarity with CPT, HCPCS, and ICD-10 coding Ability to interpret clinical documentation and treatment plans Excellent attention to detail and organizational skills Strong communication and collaboration skills across clinical and non-clinical teams Ability to manage multiple authorizations in a fast-paced, high-volume environment

WORKING CONDITIONS

Works in office setting and remotely with computer and medical records Sits for prolonged periods of time, in front of a computer screen Normal heat, light space, and safe working environment; typical of most office jobs After satisfactorily completing a probationary period, this position may be eligible for remote work on days when no travel to a facility is needed, pursuant to CH remote working policies

ENVIRONMENT

Normal heat, light space, and safe working environment; typical of most office jobs Occasional exposure to one or more mildly unpleasant physical conditions