Job Description

Job Description

Job Description

Description:

Outpatient Infusion Authorization Coordinator Nurse – Oncology – Full Time (Monday-Thursday, some Friday; 7:30 am – 4pm)

Ste. Genevieve County Memorial Hospital is a Critical Access Hospital, stand-alone, not-for-profit hospital located in Ste. Genevieve, MO that focuses on personalized care. Our 25-inpatient bed facility is a Medicare 4-star rated and is ranked in the top 1% nationally for Patient Safety, Quality, and Efficiency. SGCMH has also been recognized by Becker’s 150 Top Places to Work in Healthcare. We are proud to extend the mission of SGCMH by putting people first with excellent, personalized, and compassionate healthcare. Our deep community roots date back as the oldest town west of the Mississippi river and is the first French settlement Missouri with the hospital employing approximately 490 employees and 100 multi-specialty providers on staff. We have all the best qualities of working in a large hospital without all the hassle of driving to the city and working in a corporate environment.

Benefits are one of the ways we encourage health for you and your family. Our generous package includes medical, dental and vision coverage. But health is more than a well-working body: It encompasses body, mind and social well-being. To that end, we’ve launched a Wellness Program to address your holistic health. Our Wellness Program includes financial incentives, counseling, sick, and paid time off. We also offer retirement planning.

What to expect as a Outpatient Infusion Authorization Coordinator Nurse

• Perform review of prior authorization requests for medical necessity and level of care using sound clinical judgment to optimize patient outcome and cost effectiveness.
• Verify insurance benefits for requested chemotherapy (oral and intravenous), specialty infusions and injections, and specialized oncology labs.
• Successfully and accurately perform complex pre-certifications for oncology regimens and specialty drugs as indicated on therapy and treatment plans.
• Document all pertinent authorization information in Meditech and communicate updates or issues with clinical staff and providers in a timely and effective manner.
• Complete rechecks on existing pre-certifications by verifying insurance eligibility and all authorization information for all applicable services.
• Collaborate with Oncology staff and doctor, Physician Clinics, and Pharmacy, to obtain complete, accurate, timely clinical and financial information required for payer reimbursement, and to ensure timely insurance certification and scheduling.
• Educate providers on utilization and medical management processes and what is necessary for successful preauthorization.
• Communicate with patients to obtain and verify incomplete insurance information.
• Share clinical knowledge and act as a clinical resource to non-clinical team staff.
• Manage and oversee insurance denials, appeals, and peer to peers through to resolution in a timely fashion.
• Display effective and strong oral and written communication skills.
• Be detail-oriented and demonstrate high degree of accuracy on all work produced.
• Ability to assess, prioritize and complete multiple tasks in a stressful environment.
• Follow professional and proper telephone etiquette using interpersonal skills and required job knowledge.
• Monitor trends with outpatient medication authorizations
• Working knowledge of hospital billing and reimbursement issues as they relate to information required at time of outpatient care.
• Assist in Oncology and Specialty Infusion center in capacity of RN with acute critical patients or high census, and on a PRN basis.

Qualifications:

• RN, LPN, or other related clinical experience
• Previous insurance coding and billing experience required.
• Previous experience and knowledge of insurance authorization and verification process for major medical insurance plans and all Federal, State, and 3rd party payers required.
• Current chemotherapy, biotherapy, immunotherapy knowledge and experience preferred, Oncology and/or chemotherapy certifications a plus.
• Working knowledge and understanding of NCCN guidelines on chemotherapy regimens and indications.
• High-level understanding of medical terminology and processes.
• Ability to read and comprehend pathology and molecular lab results and relate to preauthorization process accurately.
• Prior Meditech EMR experience preferred

Your next move.

Now that you know more about being an Oncology Outpatient Specialty Infusion Authorization Coordinator on our team we hope you’ll join us. At SGCMH you’ll reaffirm every day how much you love this work, and why you were called to it in the first place. Please go to to complete an online application.

SGCMH is an equal opportunity employer. All recruiting, training, and employment decisions are made in accordance with applicable federal, state, and local laws and without regard to race, color, ancestry, national original gender, pregnancy, gender identity, sexual orientation, religion, age, disability, handicap, military or veteran status or any other legally protected status.

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