Serves as the primary clinical resource as part of the Cancer Center precertification team for the handling of complex authorization and medical necessity issues. Responsible for clinically assessing all adverse determinations made by insurers through all levels of the Pre-Service Administrative appeals process. Supports the Cancer Center precertification team to ensure precertification/authorization issues are investigated and handled expeditious and thoughtfully from an administrative, technical and clinical perspectives. Serves as the primary liaison between the Precertification Team, staff Physicians and Cancer Center Pharmacy in regard to authorization issues. Responsible for reviewing financial/insurance information obtained during the pre-registration, re-registration process to determine payer requirements are met by obtaining the appropriate referrals, pre-certification/authorization for payers in order to optimize reimbursement and avoid payment penalties.
Education Bachelors Degree : in Nursing (Required)
Experience 2 Years recent experience with Utilization Review in a hospital or in insurance company setting (Required) Previous experience with medical prior authorizations or claims experience in a managed care setting (Required) 2 Years experience in an outpatient oncological setting (Preferred)
Temple Health is a dynamic network of outstanding hospitals, specialty centers, and physician practices that is advancing the fight against disease, pushing the boundaries of medical science, and educating future healthcare professionals. Temple Health consists of Temple University Hospital (TUH), Fox Chase Cancer Center, Jeanes Hospital, TUH-Episcopal Campus, TUH-Northeastern Campus, Temple Physicians, Inc., and Temple Transport Team. Temple Health is proudly affiliated with the Lewis Katz School of Medicine at Temple University.
To support this mission, Temple University Health System is continuously recruiting top talent to join its diverse, 10,000 strong workforce that fosters a healthy, safe and productive environment for its patients, visitors, students and colleagues alike. At Temple Health, your tomorrow is here!
Your Tomorrow is Here!
Temple University Hospital is a nationally respected teaching hospital on Temple University's bustling Health Sciences Center campus. The hospital provides a comprehensive array of healthcare services both basic and complex to patients from around the corner, across the country and around the world. As the chief clinical training site for the Lewis Katz School of Medicine at Temple University, the hospital provides a dynamic environment for high-quality care, teaching, and cutting edge research.
Mount Sinai is among New York City's largest employers, with 38,000+ team members in both clinical and non-clinical roles throughout our seven hospital campuses and world-renowned medical school. We are one of the metro area's largest health care providers, with hundreds of ambulatory, primary, and specialty care facilities across the five boroughs, northeastern region and beyond.