Insurance Reviewer-Clinical

The US Oncology Network • Fort Worth, TX

3d • Remote

About The Position

The US Oncology Network is looking for an Clinical Insurance Reviewer to join our team at Texas Oncology. This full-time remote position will support the Central Imaging Scheduling Department at our 500 South Henderson Suite 400 clinic in Fort Worth, Texas. Typical work week is Monday through Friday, 8:30a - 5:00p. This position will be either a level 1 or Sr based on candidate work experience. As a part of The US Oncology Network, Texas Oncology delivers high-quality, evidence-based care to patients close to home. Texas Oncology is the largest community oncology provider in the country and has approximately 530 providers in 280+ sites across Texas, our founders pioneered community-based cancer care because they believed in making the best available cancer care accessible to all communities, allowing people to fight cancer at home with the critical support of family and friends nearby. Our mission is still the same today—at Texas Oncology, we use leading-edge technology and research to deliver high-quality, evidence-based cancer care to help our patients achieve “More breakthroughs. More victories.” ® in their fight against cancer. Today, Texas Oncology treats half of all Texans diagnosed with cancer on an annual basis. The US Oncology Network is one of the nation’s largest networks of community-based oncology physicians dedicated to advancing cancer care in America. The US Oncology Network is supported by McKesson Corporation focused on empowering a vibrant and sustainable community patient care delivery system to advance the science, technology, and quality of care.

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.
• 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 documentation issues, and payer issues.
• Updates coding/payer guidelines for clinical staff.
• Obtains insurance authorization and pre-certification for services. Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
• Maintains a good working knowledge of 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