UCSD Layoff from Career Appointment: Apply by 10/08/21 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor.
Special Selection Applicants: Apply by 10/20/21. Eligible Special Selection clients should contact their Disability Counselor for assistance.
Under the direct supervision of the Revenue Cycle Oncology Manager, the Oncology Authorization & Reimbursement Specialists functions independently as an expert for the department and serves as a liaison between the Medical Center, Medical Group, Moores Cancer Center La Jolla, and Encinitas Cancer Center Business Offices. Will have involvement with patient, third party, government, physician billing, collections, coding, registration, authorizations, pre-determinations and financial counseling/patient assistance activities.
Provides for coordinated processes, procedures and systems, customer service delivery models and ensuring compliance with internal policy and external agency regulations. Manages insurance reimbursement from third-party billing and government insurance programs by ensuring proper diagnosis coding, verification of medical necessity guidelines, supporting documentation (e.g. journal notes, literature, etc.) to support off-label treatment recommendations and by working collaboratively with clinical care and finance teams to ensure the financial stability of UC San Diego Health System.
Keeps abreast of the full array of third-party contracts and billing/collections requirements, health plan/IPA contracts and ICD-10/HCPCS coding changes. Ensures, via Patient Assistance Programs and Financial Counselors, proper cash posting, accounts receivable management and financial counseling for securing collections of accounts. Works closely with Financial Counselors, Patient Financial Services, Health Information Management and entire clinical care team to ensure proper authorization and financial clearance of high dollar oncology accounts Investigates highly complex, high dollar claims, evaluate alternative funding sources for patients in need, and propose procedures and systems in support of efficient workflows and maximization of reimbursement.
Will have the ability to read and analyzing operative reports, pt. accounts, claims/EOB's for correct ICD-10, CPT/HCPCS coding, proper use of modifiers and be able to verify that medical necessity guidelines have been met. Will be required to have a high level of critical thinking skills and be expected to work independently to respond to and resolve issues related to authorization, reimbursement, registration, patient assistance, financial counseling and/or coding issues related to high dollar oncology accounts.
The role includes daily monitoring of Department Activity Reports (DAR) in EPIC and Referral WQ's for all oncology departments. Performs authorization appeals and conducts research on denials and patient complaints. The Oncology Authorization & Reimbursement Specialist will also assists with coding operations when needed. Will update the department of any changes and issues including training and coaching and implementation of new process with department staff and managers. Will provide support for Moores Cancer Center and Encinitas Cancer Center in the areas of authorizations, coding, registration and other administrative roles/functions as needed.
The Oncology Authorization & Reimbursement Specialist will be required to travel and work in multiple locations, work weekends and evening shift, holidays as needed. Will also provide support to departmental leadership, staff and faculty. Will develop and facilitate performance improvement projects. Will have superior communication skills, both written and verbal. Utmost sense of professionalism and discretion. Ability to independently execute tasks and multi-task effectively. Detail oriented and exceptional organizational skills. Ability to independently prioritize, complete projects, and manage deadlines and expectations.
Flexible approach to manage shifting priorities and work schedule (ability to work a different work schedule and/or location). Job standards to be performed at the EXPERT level.
Seven (7) years of related experience, education/training, OR a Bachelor's degree in related area plus three (3) years of related experience/training.
Demonstrated knowledge of medical terminology and coding.
Experience and proven success in billing and/or authorization processes, concepts, systems and external regulations.
Previous experience in an outpatient oncology clinic or pharmacy setting.
Previous experience reviewing and interpreting on-label and off-label indications.
UC San Diego is an academic powerhouse and economic engine, recognized as one of the top 8 public universities by U.S. News and World Report. Innovation is central to who we are and what we do. Here, students learn that knowledge isn't just acquired in the classroom - life is their laboratory. UC San Diego's rich academic portfolio includes six undergraduate colleges, five academic divisions and five graduate and professional schools. The university's award-winning scholars are experts at the forefront of their fields with an impressive track record for achieving scientific, medical and technological breakthroughs.