Outside Scheduler/Insurance Reviewer Sr–Remote

The US Oncology Network•Odessa, TX

7h•Remote

About The Position

Texas Oncology is seeking an experienced Outside Scheduler/Insurance Reviewer Sr for a REMOTE position supporting West Region locations. This role is crucial in managing physician referrals, outside testing schedules, and ensuring timely reimbursement for treatments by reviewing chemotherapy regimens, obtaining pre-certifications, and researching denied services. The position also involves patient communication regarding appointments and necessary preparations, acting as a liaison between patients, medical staff, and referring offices, and adhering to compliance programs.

Requirements

High school degree or equivalent.
Minimum three (3) years medical insurance verification and authorization experience required.
Minimum two (2) years clinical review experience required.
Possesses up to date knowledge of the profession and industry; is quick learner 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 in 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 HIPAA laws and guidelines with regards to patients records.
Other duties as requested or assigned.