Insurance Authorization Specialist

The US Oncology Network•Abilene, TX

2d•Remote

About The Position

The US Oncology Network is seeking an Insurance Authorization Specialist for Texas Oncology. This full-time remote position supports the Oncology Department at the 1957 Antilley Road clinic in Abilene, Texas. The typical schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m. The position may be Level 1 or Senior, depending on the candidate’s work experience. Under general supervision, the specialist reviews chemotherapy regimens against reimbursement guidelines and obtains required pre-certifications and exceptions to help prevent treatment reimbursement delays. The role also investigates denied or non-covered services and identifies alternative resources to pay for treatment. The specialist supports and adheres to the US Oncology Compliance Program, including its Code of Ethics and Business Standards.

Requirements

High school degree or equivalent.
For the Senior level, at least three years of medical insurance verification and authorization experience and at least two years of clinical review experience are required.
Maintain confidentiality and comply with applicable patient-record laws and guidelines.
Meet the role’s physical demands, including sitting or standing, talking or hearing, handling and lifting patients, standing and walking for extended periods, and occasionally lifting or carrying items weighing up to 40 pounds.

Nice To Haves

Associate degree in Healthcare.
LPN state license and registration.
At least three years of medical insurance verification and authorization experience for Level 1.

Responsibilities

Review, process, and audit medical necessity for each patient’s chemotherapy treatment and documentation of the regimen relative to pathway adherence.
Communicate insurance-plan restrictions and special requirements to nursing and medical staff.
Provide physicians and management with prompt feedback about pathway documentation issues and payer issues involving non-covered chemotherapy drugs.
Update coding and payer guidelines for clinical staff, track pathways, and perform other business office functions as needed.
Obtain insurance authorization and pre-certification for chemotherapy services.
Advocate for patients and serve as a liaison between patients and payers to answer reimbursement questions and help avoid insurance delays.
Research additional or alternative resources for non-covered chemotherapy services to prevent payment denials.
Provide patients with contact information for community resources, including special programs, drugs and pharmaceutical supplies, and financial resources.
Maintain working knowledge of chemotherapy authorization requirements for all payers and state and federal coverage and authorization regulations.
Protect patient-record confidentiality and comply with applicable state and federal laws and HIPAA guidelines.
Perform other duties as requested or assigned.