Oncology Revenue Integrity Specialist

Summary

Southwest General Health Center is a 352-bed community hospital located in Middleburg Heights Ohio. One of the last standing community hospitals in Northeast Ohio we partner with University Hospitals and other local community organizations to provide a full range of services to all who need us. We are certified as a Level III Trauma Center and a Primary Stroke Center and have been serving our community for over 100 years!

At Southwest General we believe in the power of teamwork creating a family-like environment ensuring a work-life balance and providing meaningful work to make a real difference in peoples lives.

We value our employees as much as our patients offering a supportive work culture that encourages growth development and collaboration. Were committed to building a team that works together supports each other and ultimately saves lives every day.

At Southwest you are family.

Position summary:

The Revenue Integrity Specialist is responsible for facilitating proper charge capture billing and adjudication of claims in accordance with standard Billing policies and reimbursement principles clinical documentation practices and CPT/HCPCS and ICD-10CM coding through the use of the hospitals electronic information systems and manual processes. This position will be responsible for ensuring that all billing charges are captured in an appropriate manner for the Hospitals oncology services specifically focusing on infusion injection targeted therapies diagnostic testing and radiation therapy treatments.

This person will identify analyze and reconcile billing errors or omissions while ensuring timely verification authorization and documentation of insurance requirements for oncology and infusion services. This position serves as a key liaison between providers patients payers and revenue cycle teams to ensure compliance with medical necessity criteria payer policies and regulatory requirements while minimizing treatment delays and denials.

The specialist proactively reviews treatment plans against payer guidelines support authorizations manages appeals and supports financial stewardship of the cancer center through accurate and compliant reimbursement practices. This person must be familiar with standard concepts practices and procedures in healthcare. The applicant will be responsible to perform a variety of tasks as assigned and will work under general supervision of the Revenue Integrity and Cancer Center Leadership.

MINIMUM QUALIFICATIONS

Education: Associate degree required bachelors degree preferred. Equivalent combination of education and healthcare experience may be considered.

Required length and type of experience:

• Experience with Medicare Medicaid and commercial insurance plans.
• Experience working in a cancer center oncology practice infusion center or hospital oncology department preferred.
• Minimum 35 years of experience in:
  • Oncology prior authorization
  • Utilization management
  • Medical necessity review
  • Oncology reimbursement
  • Revenue cycle operations
• Strong understanding of:
  • Oncology treatment regimens
  • Medical necessity standards
  • Prior authorization processes
  • Payer reimbursement methodologies
  • Clinical documentation requirements
  • Insurance benefit structures

Required licensure certification or registry: Certified Coding Specialist (CCS) preferred and/orUtilization Review or Case Management certification preferred