Insurance Authorization Specialist

The US Oncology Network•San Antonio, TX

2d•Remote

About The Position

The US Oncology Network is looking for an Insurance Authorization Specialist to join their team at Texas Oncology. This is a full-time remote position that will support the Referrals Department. The role involves reviewing chemotherapy regimens, obtaining pre-certifications and exceptions, and researching denied services to ensure timely reimbursement. The specialist will also adhere to the US Oncology Compliance Program. This position can be either a Level 1 or Senior level, depending on the candidate's experience.

Requirements

High school degree or equivalent.
Minimum three (3) years medical insurance verification and authorization preferred.
Minimum three (3) years medical insurance verification and authorization and two (2) years clinical review experience required.

Nice To Haves

Associates degree in Healthcare
LPN state license and registration preferred.

Responsibilities

Reviews, processes and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence.
Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans.
Provides prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered chemotherapy drugs.
Updates coding/payer guidelines for clinical staff.
Tracks pathways and performs various other business office functions on an as needed basis.
Obtains insurance authorization and pre-certification specifically for chemotherapy services.
Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
Researches additional or alternative resources for non-covered chemotherapy services to prevent payment denials.
Provides a contact list for patients community resources including special programs, drugs and pharmaceutical supplies and financial resources.
Maintains a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization.
Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patients records.
Other duties as requested or assigned.