Clinical Insurance Reviewer (Healthcare)

Location: Remote role associated with Englewood, Colorado and Norfolk, Virginia; responsibilities may require presence at an employee site during scheduled business hours and minimal travel to office sites.

Salary: $23–$26 per hour, depending on experience.

Company

Community-based oncology care organization supported by a major healthcare corporation and focused on advancing cancer treatment delivery, quality, and access.

What you will do

• Review and audit the medical necessity of chemotherapy treatments, documentation, and pathway adherence.
• Obtain insurance authorizations and pre-certifications for chemotherapy services.
• Communicate payer restrictions and special requirements to nursing and medical staff.
• Research denied or non-covered chemotherapy services and identify alternative payment and assistance resources.
• Act as a liaison between patients and payers to resolve reimbursement questions and prevent treatment delays.
• Update coding and payer guidelines and support related business office functions.

Requirements

• High school diploma or equivalent.
• At least three years of medical insurance verification and authorization experience.
• Current knowledge of chemotherapy authorization requirements, payer policies, and state and federal coverage regulations.
• Ability to maintain confidentiality and comply with HIPAA and applicable legal requirements.
• Ability to work scheduled business hours, with potential in-person interaction and physical activity at an employee site.

Nice to have

• Associate degree in healthcare.
• LPN state license and registration.

Culture & Benefits

• Remote work arrangement with possible minimal travel to office sites.
• Medical, dental, and vision insurance.
• 401(k) plan with matching contributions.
• Life insurance and short- and long-term disability coverage.
• Wellness and additional employee benefits programs.