Oncology Insurance Spec

Philadelphia, PA, US, 19104

Job Type: 

BUERGER - Buerger Center Ambulatory Care Req ID: 27544

Shift: Days

Employment Status: AP - Active - Regular - Part Time 

Job Summary

The Insurance Specialist will work in collaboration with clinical staff to standardize and streamline the verification and authorization process for all Endocrinology HI Center referrals. This would include all possible visits, tests, procedures, and treatment plans - for both new patients and second opinion referrals. Use of the patients’ record to both access and document information which supports authorization, therefore, insuring a systematical approach to sharing critical information. Network with other precertification/insurance employees across CHOP’s billing entities to stay abreast of and share recent changes, updates, and processes. Provide complete information to the Single Case Agreement Team on initial request in an effort to facilitate an agreed to systematical process for non-par insurance plans.  Maintain and develop clear lines of communication with insurance representatives from multiple insurance companies who can provide precertification/authorization guidelines unique to their company. The Insurance Specialist will develop the role so as to be a resource/mentor and leader to other CHOP staff members who perform similar work. Provide guidance and share knowledge with staff in regards to insurance authorization/intake/registration. Must be able to effectively manage work across department and work independently with minimal supervision and participate in administrative decisions. Strong communication skills, attention to detail and a high level of organization are critical qualities. 

Job Responsibilities

Responsible for verifying and authorizing the insurance of all new patients referred into the division of endocrinology’s HI Center as well obtaining emergency authorization for scans/tests for all existing patients.
•    Obtain authorization for all non par scans or procedures 
•    Communicates directly with disease specialists and clinical staff regarding status of authorization and the need for clinical documentation
•    Verify coverage & benefit information via electronic eligibility or by contacting the payer
•    Document all relevant information into EPIC
•    Partners with Single Case Agreement Department to facilitate authorizations
•    Establishes process with Revenue Cycle to insure collection of payment, especially for non par insurance companies
•    Partners with Revenue Cycle and billing to collect any backlogged revenue 

Educates families and clinical team regarding insurance coverage plans.  
•    Communicates with family and/or responsible party, as necessary, to inform them of any insurance problems or restrictions, ensuring that insurance information is clearly relayed to and understood by family and/or responsible party.  
•    Respond to emails, answer calls, provide explanation of covered and non-covered services
•    Contacts appropriate clinical staff in timely manner with all information that requires follow-up. 
•    Develop and maintain systems to streamline communication with staff on all aspects of insurance 
•    Completes abbreviated assessment to determine family eligibility for Family Health Care Coverage programs and refer to FHCC when appropriate.

Training/Education Responsibilities
•    Educates providers, intake coordinators and families on insurance issues
•    Assists in creating brochure which provides insurance information for families
•    Creates templates with correct CPT Codes for specific services for Single Case Agreement 
Registration Responsibilities
•    Create and/or update patient record by verifying demographic, insurance information, or proper study identification in the registration system
•    Ensure specific registration fields are accurately inputted into registration system, including but not limited to visit notes, referral/authorization numbers, eligibility review, proper payer plan entries for research and standard-of-care visits
•    Verify coverage through Navinet/Passport, etc. and pull appropriate referrals.
•    Coordinate & communicate insurance issues with appropriate personnel (e.g. schedulers, Pre-cert dept, out-of –area dept, Self-Pay group, Single Case Agreement Team and PCP’s staff when required. 
•    Educate and inform family of outstanding financial obligations if appropriate.  Provide documentation in Guarantor’s Notes in Epic.

Required Education and Experience

Required Education: High School/GED


Required Experience:

  • At least five (5) years of related healthcare registration, billing and/or reimbursement experience
  • Previous experience in complex clinical setting that required coordination of multiple services
  • Background in Medical Insurance
Preferred Education, Experience & Cert/Lic

Preferred Education: Associate’s or Bachelor’s degree


Preferred Experience:

  • Resource scheduling experience (e.g. ancillary testing)
Additional Technical Requirements
  • Advanced insurance authorization and registration techniques
  • Ability to provide training to staff in complexity of Insurance Authorization
  • High level of interpersonal skills with excellent customer service and responsiveness
  • Background in medical terminology
  • Strong Customer Service experience required
  • Ability to multi-task and prioritize is crucial to success in the position
  • Individual must be highly organized and dependable
  • Ability to prioritize and work on several projects at once while maintaining communication with all invested parties.
  • Strong communication skills
  • Ability to work with stressful situations
  • Ability to function efficiently and professionally with minimum of supervision.
  • Ability to quickly learn new procedures.
  • Strong computer skills.
  • Ability to juggle multiple insurance issues.
  • Strong customer service skills
  • Ability to display compassion and empathy
  • Website Insurance Training (Navinet, WebMD, Passport)
  • EPIC training & testing (Prelude/Cadence). 

All CHOP employees who work in a patient building or who provide patient care are required to receive an annual influenza vaccine unless they are granted a medical or religious exemption.

Children's Hospital of Philadelphia is committed to providing a safe and healthy environment for its patients, family members, visitors and employees. In an effort to achieve this goal, employment at Children's Hospital of Philadelphia, other than for positions with regularly scheduled hours in New Jersey, is contingent upon an attestation that the job applicant does not use tobacco products or nicotine in any form and a negative nicotine screen (the latter occurs after a job offer).

Children's Hospital of Philadelphia is an equal opportunity employer. We do not discriminate on the basis of race, color, gender, gender identity, sexual orientation, age, religion, national or ethnic origin, disability or protected veteran status.

VEVRAA Federal Contractor/Seeking priority referrals for protected veterans.  Please contact our hiring official with any referrals or questions.

CHOP Careers Contact 

Talent Acquisition

2716 South Street, 6th Floor

Philadelphia, PA 19146 

Phone: 866-820-9288




Nearest Major Market: Philadelphia

Job Segment: Oncology, Endocrinology, Medical, EMR, Patient Care, Healthcare