Insurance Authorization Specialist

The US Oncology Network • San Antonio, TX

5h • Remote

About The Position

The US Oncology Network is looking for an Insurance Authorization Specialist to join their team at Texas Oncology. This full-time remote position will support the Radiation/Radiology Department at their 100 NE Loop 410 #600 location in San Antonio, Texas. The typical work week is Monday through Friday, 8:00a - 5:00p. This position will be either a level 1 or Sr based on candidate work experience. As part of The US Oncology Network, Texas Oncology delivers high-quality, evidence-based care to patients close to home, being the largest community oncology provider in the country with approximately 530 providers in 280+ sites across Texas. Their mission is to use leading-edge technology and research to deliver high-quality, evidence-based cancer care. The US Oncology Network is one of the nation’s largest networks of community-based oncology physicians, supported by McKesson Corporation, focused on empowering a vibrant and sustainable community patient care delivery system. Under general supervision, the Insurance Authorization Specialist reviews chemotherapy regimens in accordance with reimbursement guidelines, obtains necessary pre-certifications and exceptions to ensure no delay in reimbursement of treatments, and researches denied services and alternative resources to pay for treatment. The specialist supports and adheres to the US Oncology Compliance Program, including the Code of Ethics and Business Standards.

Requirements

• High school degree or equivalent.
• Minimum three (3) years medical insurance verification and authorization (required for Sr level).
• Two (2) years clinical review experience (required for Sr level).
• Possesses up to date knowledge of the profession and industry; is regarded as an expert in the technical/functional area; accesses and uses other expert resources when appropriate.
• Handles day to day work challenges confidently; is willing and able to adjust to multiple demands, shifting priorities, ambiguity and rapid change; shows resilience inn the face of constraints, frustrations, or adversity; demonstrates flexibility.
• Makes timely, cost effective and sound decisions; makes decisions under conditions of uncertainty.
• Sets high standards of performance; pursues aggressive goals and works efficiently to achieve them.
• Emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluated products, processes, and service against those standards; manages quality; improves efficiencies.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 501-1,000 employees