Kettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio. We are committed to transforming the health care experience with high-quality care for every stage of life. Our service-oriented mission is in action every day, whether it’s by providing care in our facilities, training the next generation of health care professionals, or serving others through international outreach.
This position is responsible for the authorizations for all chemotherapy/infusion services at Kettering Cancer Care. This role will obtain accurate and timely decisions from payers regarding authorizations of chemotherapy, infusion, injection therapy and any other procedure requiring authorization on the Grandview infusion floor. This position requires excellent time management and organizational skills as well as the ability to provide clear and concise communication, both verbally and written. This position is empowered to approve, pend or deny services for our population of patients according to policy. This position requires strong knowledge of ICD9/10 diagnosis codes as well as CPT codes
The employee communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with insurance plans. He/she provides prompt feedback to physicians and management regarding any payer issues with non-covered chemotherapy/infusion drugs. He/she uses the EPIC/Beacon work que and referral entry to maintain all new authorizations and expiring authorizations.