Insurance Authorization Specialist

The US Oncology Network•Wichita Falls, TX

20h•Remote

About The Position

The US Oncology Network is seeking an Insurance Authorization Specialist to join Texas Oncology. This full-time remote role supports the Oncology Department in Wichita Falls, Texas, and applicants must currently reside in Texas. The work week is Monday through Friday, 8:00 a.m. to 5:00 p.m. The position may be classified as Level 1 or Senior based on the candidate’s work experience. Under general supervision, the specialist reviews chemotherapy regimens according to reimbursement guidelines and obtains required pre-certifications and exceptions to prevent treatment reimbursement delays. The role researches denied services and alternative sources of payment, supports the US Oncology Compliance Program, and follows its Code of Ethics and Business Standards. The specialist also serves as a patient advocate and liaison between patients and payers.

Requirements

High school degree or equivalent.
For the Senior level, at least three years of medical insurance verification and authorization experience and two years of clinical review experience are required.
Must currently reside in Texas.
Work effectively with changing demands, shifting priorities, ambiguity, and rapid change.
Use sound judgment to make timely, cost-effective decisions, including under uncertainty.
Set high performance standards and work efficiently toward challenging goals.
Emphasize quality and evaluate products, processes, and services against quality standards.

Nice To Haves

Associate degree in Healthcare.
LPN state license and registration.
For Level 1, at least three years of medical insurance verification and authorization experience is preferred.

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 authorizations and pre-certifications specifically for chemotherapy services.
Serve as a patient advocate and liaison between patients and payers, answering reimbursement questions and helping avoid insurance delays.
Research additional or alternative resources for non-covered chemotherapy services to prevent payment denials.
Provide patients with contact lists 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 guidelines.
Protect patient-record confidentiality and follow applicable state and federal laws and HIPAA guidelines.
Support and adhere to the US Oncology Compliance Program, including its Code of Ethics and Business Standards.
Perform other duties as requested or assigned.