Maryland Oncology Hematology
Insurance Authorization Specialist
Maryland Oncology Hematology, Irving, Texas, United States, 75084
Insurance Authorization Specialist
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Insurance Authorization Specialist
role at
Maryland Oncology Hematology . This full‑time hybrid position supports Proton Radiation and Chemo Regimens at our clinic.
Overview The US Oncology Network is looking for an Insurance Authorization Specialist to join our team at
Texas Oncology . This position will support the Proton Radiation and Chemo Regimens at our 1501 W. Royal Lane clinic in Irving, Texas. Typical work week is Monday through Friday, 8:00 a.m. - 4:30 p.m. This position will be either a Level 1 or Sr based on candidate work experience.
Responsibilities
Review, process, and audit medical necessity documentation for proton beam radiation therapy and select chemotherapy regimens.
Coordinate peer-to-peer reviews and prepare appeal letters for denied insurance cases.
Obtain insurance authorizations and pre-certifications specifically for proton radiation treatments and select chemotherapy regimens.
Serve as a patient advocate and liaison between patients and insurance payers to address reimbursement inquiries and prevent treatment delays.
Educate patients on the authorization process, including peer-to-peer reviews and appeals.
Maintain current knowledge of authorization requirements across all payers, as well as state and federal regulations related to coverage and authorization.
Ensure strict compliance with confidentiality standards, including HIPAA and other state and federal patient privacy regulations.
Perform additional duties as assigned.
Qualifications Level 1
High school degree or equivalent.
Associate degree in Healthcare, LPN state license and registration preferred.
Minimum three (3) years medical insurance verification and authorization preferred.
Level Sr
Minimum three (3) years medical insurance verification and authorization and two (2) years clinical review experience required.
Competencies
Uses Technical and Functional Experience: possesses up‑to‑date knowledge of the profession and industry; regarded as an expert in the technical/functional area; accesses other expert resources when appropriate.
Demonstrates Adaptability: handles day‑to‑day work challenges confidently; 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.
Uses Sound Judgment: makes timely, cost‑effective and sound decisions; makes decisions under conditions of uncertainty.
Shows Work Commitment: sets high standards of performance; pursues aggressive goals and works efficiently to achieve them.
Commits to Quality: emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluates products, processes, and service against those standards; manages quality and improves efficiencies.
Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients and manual and finger dexterity, and eye‑hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.
Work Environment The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in‑person interaction with co‑workers and management and/or clients.
Seniority Level Mid-Senior level
Employment type Full‑time
Job function Other
Industries Hospitals and Health Care
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Insurance Authorization Specialist
role at
Maryland Oncology Hematology . This full‑time hybrid position supports Proton Radiation and Chemo Regimens at our clinic.
Overview The US Oncology Network is looking for an Insurance Authorization Specialist to join our team at
Texas Oncology . This position will support the Proton Radiation and Chemo Regimens at our 1501 W. Royal Lane clinic in Irving, Texas. Typical work week is Monday through Friday, 8:00 a.m. - 4:30 p.m. This position will be either a Level 1 or Sr based on candidate work experience.
Responsibilities
Review, process, and audit medical necessity documentation for proton beam radiation therapy and select chemotherapy regimens.
Coordinate peer-to-peer reviews and prepare appeal letters for denied insurance cases.
Obtain insurance authorizations and pre-certifications specifically for proton radiation treatments and select chemotherapy regimens.
Serve as a patient advocate and liaison between patients and insurance payers to address reimbursement inquiries and prevent treatment delays.
Educate patients on the authorization process, including peer-to-peer reviews and appeals.
Maintain current knowledge of authorization requirements across all payers, as well as state and federal regulations related to coverage and authorization.
Ensure strict compliance with confidentiality standards, including HIPAA and other state and federal patient privacy regulations.
Perform additional duties as assigned.
Qualifications Level 1
High school degree or equivalent.
Associate degree in Healthcare, LPN state license and registration preferred.
Minimum three (3) years medical insurance verification and authorization preferred.
Level Sr
Minimum three (3) years medical insurance verification and authorization and two (2) years clinical review experience required.
Competencies
Uses Technical and Functional Experience: possesses up‑to‑date knowledge of the profession and industry; regarded as an expert in the technical/functional area; accesses other expert resources when appropriate.
Demonstrates Adaptability: handles day‑to‑day work challenges confidently; 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.
Uses Sound Judgment: makes timely, cost‑effective and sound decisions; makes decisions under conditions of uncertainty.
Shows Work Commitment: sets high standards of performance; pursues aggressive goals and works efficiently to achieve them.
Commits to Quality: emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluates products, processes, and service against those standards; manages quality and improves efficiencies.
Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients and manual and finger dexterity, and eye‑hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.
Work Environment The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in‑person interaction with co‑workers and management and/or clients.
Seniority Level Mid-Senior level
Employment type Full‑time
Job function Other
Industries Hospitals and Health Care
#J-18808-Ljbffr