Insurance Reviewer-Clinical (Oncology)

Location: On-site in Wichita, Kansas, United States; Monday–Friday, 8:30 AM–5:00 PM. No weekends, on-call shifts, or major holidays.

Company

The Cancer Center of Kansas is part of hirify.global, a community-based oncology network supported by McKesson Corporation.

What you will do

• Review chemotherapy regimens, treatment orders, and clinical documentation against reimbursement guidelines and standards of care.
• Obtain prior authorizations, referrals, pre-certifications, and exceptions for chemotherapy, injections, radiology, laboratory services, scans, and follow-up visits.
• Provide clinical information to insurance companies and case managers and coordinate peer-to-peer calls between physicians and payers.
• Communicate with referring physicians, doctor offices, facilities, and insurance companies through portals, websites, phone, and fax.
• Track authorization and referral status, upload documentation to the practice management system and EMR, and maintain accurate records.
• Follow payer requirements, oncology authorization procedures, compliance standards, confidentiality rules, and HIPAA guidelines.

Requirements

• High school diploma or equivalent.
• At least three years of medical insurance verification and authorization experience.
• Current knowledge of chemotherapy authorization requirements and state and federal coverage regulations.
• Ability to multitask, adapt to shifting priorities, use sound judgment, and communicate through multiple channels.
• Ability to work on-site at the employee location during regularly scheduled business hours.

Nice to have

• Associate degree in healthcare or a business-related field.

Culture & Benefits

• Medical, dental, and vision coverage.
• 401(k) plan with matching contributions.
• Life insurance and short- and long-term disability coverage.
• FSA, HSA, paid time off, wellness, and perks programs.
• Work in an oncology and hematology clinic environment with in-person collaboration and minimal travel between office sites.