Facility: Administrative Regional Training Cntr
Shift: Shift 1
Status: Full Time
FTE: 1.000000
Bargaining Unit: ACE Associates
Exempt from Overtime: Exempt: Yes
Work Schedule: Days
Hours:
7-4, 8-4 flexible
Summary:
Under the direction of the Manager Revenue Integrity, including oversight from System revenue cycle leadership, Outpatient Clinical Documentation Improvement Specialist ("OP CDS") is responsible for securing insurance authorizations for complex infusions therapies that include, but not limited to oncology, chemotherapy, and biologic. This role requires specialized knowledge of oncology treatment regimens, payer requirements, and high-cost specialty medications to ensure timely access to care and accurate reimbursement.
This position partners closely with providers, pharmacy, revenue integrity, scheduling, prior authorization and billing teams to ensure all authorization requirements are met prior to treatment. The specialist plays a critical role in minimizing denials, identifying payer trends, and supporting compliant efficient workflows across the revenue cycle.
The Outpatient Clinical Documentation Improvement Specialist ("OP CDS") is responsible for activities which improve the accuracy of facility outpatient clinical documentation and charging including education with the clinical departments and root cause correction to support accurate charging and coding in compliance with Hospital/Health System policies related to infusions. The OP CDS assists clinical areas to effectively document services and understand the relationship of documentation, medical necessity, and charging for the services provided in accordance with Hospital/Health System policies and procedures. This position supports a multi-facility health system, and as such, requires the ability to travel to various Catholic Health facilities throughout the Health System.
Responsibilities:
EDUCATION
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Bachelor's degree or over five (5) years of related healthcare experience in lieu of degree
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Certified Medical Assistant (CMA), Registered Medical Assistant (RMA), or the following credentials RN, LPN, RHIA, RHIT, CPC, COC, or CDEO required
EXPERIENCE
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Minimum of 2-4 years of prior authorization experience in oncology, infusion services, or specialty medications
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Strong preference for experience with chemotherapy regimens, infusion scheduling, or oncology workflows
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Experience working with Epic, preferred
KNOWLEDGE, SKILL AND ABILITY
- Strong understanding of oncology/infusion therapies and complex medication regimens
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Knowledge of payer authorization requirements, medical necessity criteria, and reimbursement structures
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Familiarity with CPT, HCPCS, and ICD-10 coding
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Ability to interpret clinical documentation and treatment plans
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Excellent attention to detail and organizational skills
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Strong communication and collaboration skills across clinical and non-clinical teams
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Ability to manage multiple authorizations in a fast-paced, high-volume environment
WORKING CONDITIONS:
- Works in office setting and remotely with computer and medical records
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Sits for prolonged periods of time, in front of a computer screen
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Normal heat, light space, and safe working environment; typical of most office jobs
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After satisfactorily completing a probationary period, this position may be eligible for remote work on days when no travel to a facility is needed, pursuant to CH remote working policies
ENVIRONMENT
- Normal heat, light space, and safe working environment; typical of most office jobs
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Occasional exposure to one or more mildly unpleasant physical conditions
