The US Oncology Network
Insurance Authorization Specialist
The US Oncology Network, San Antonio, Texas, United States, 78208
Join to apply for the
Insurance Authorization Specialist
role at
The US Oncology Network .
Overview The US Oncology Network is looking for an
Insurance Authorization Specialist
to join our team at
Texas Oncology . This full‑time remote position will support the Revenue Cycle Department at our 100 NE Loop 410 #600 location in San Antonio, Texas. The typical work week is Monday through Friday, 8:00 a.m. – 5:00 p.m.
This position will be either a Level 1 or Senior 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 its mission is to use leading‑edge technology and research to deliver high‑quality, evidence‑based cancer care to help patients achieve “More breakthroughs. More victories.”® in their fight against cancer.
Responsibilities
Reviews, processes, and audits medical necessity for each patient’s chemotherapy treatment, documenting the 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 and tracks pathways while performing various business office functions as needed.
Obtains insurance authorization and pre‑certification for chemotherapy services, acting as patient advocate and liaison between patient and payer to answer reimbursement questions and avoid insurance delays.
Researches alternative resources for non‑covered chemotherapy services to prevent payment denials, and supplies a contact list for patients of community resources including special programs, drugs, pharmaceutical supplies and financial resources.
Maintains knowledge of chemotherapy authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization, and adheres to confidentiality, HIPAA laws and guidelines regarding patient records.
Other duties as requested or assigned.
Qualifications Level 1
High school degree or equivalent.
Associate’s degree in Healthcare, LPN state license and registration preferred.
Minimum three (3) years medical insurance verification and authorization experience preferred.
Level Senior
Minimum three (3) years medical insurance verification and authorization and two (2) years clinical review experience required.
Competencies
Technical and functional expertise; recognized as an expert in the area and utilizes other expert resources as appropriate.
Adaptability; handles day‑to‑day work challenges confidently, adjusts to multiple demands, shifting priorities, ambiguity and rapid change, and demonstrates resilience.
Sound judgment; makes timely, cost‑effective and sound decisions under uncertainty.
Work commitment; sets high performance standards, pursues goals aggressively and works efficiently.
Commitment to quality; emphasizes delivering quality products/services, defines quality standards, evaluates against them, manages quality and improves efficiencies.
Physical Demands Requires presence at the employee site during regularly scheduled business hours; requires sitting, standing and walking. Requires full range of body motion, handling and lifting patients, manual and finger dexterity, eye‑hand coordination, standing and walking for extensive periods, occasionally lifting up to 40 lb. Requires normal vision and hearing.
Work Environment Environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic. Work requires in‑person interaction with coworkers and management and/or clients, and may require minimal travel by automobile.
Seniority level Mid‑Senior level
Employment type Full‑time
Job function Other
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Insurance Authorization Specialist
role at
The US Oncology Network .
Overview The US Oncology Network is looking for an
Insurance Authorization Specialist
to join our team at
Texas Oncology . This full‑time remote position will support the Revenue Cycle Department at our 100 NE Loop 410 #600 location in San Antonio, Texas. The typical work week is Monday through Friday, 8:00 a.m. – 5:00 p.m.
This position will be either a Level 1 or Senior 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 its mission is to use leading‑edge technology and research to deliver high‑quality, evidence‑based cancer care to help patients achieve “More breakthroughs. More victories.”® in their fight against cancer.
Responsibilities
Reviews, processes, and audits medical necessity for each patient’s chemotherapy treatment, documenting the 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 and tracks pathways while performing various business office functions as needed.
Obtains insurance authorization and pre‑certification for chemotherapy services, acting as patient advocate and liaison between patient and payer to answer reimbursement questions and avoid insurance delays.
Researches alternative resources for non‑covered chemotherapy services to prevent payment denials, and supplies a contact list for patients of community resources including special programs, drugs, pharmaceutical supplies and financial resources.
Maintains knowledge of chemotherapy authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization, and adheres to confidentiality, HIPAA laws and guidelines regarding patient records.
Other duties as requested or assigned.
Qualifications Level 1
High school degree or equivalent.
Associate’s degree in Healthcare, LPN state license and registration preferred.
Minimum three (3) years medical insurance verification and authorization experience preferred.
Level Senior
Minimum three (3) years medical insurance verification and authorization and two (2) years clinical review experience required.
Competencies
Technical and functional expertise; recognized as an expert in the area and utilizes other expert resources as appropriate.
Adaptability; handles day‑to‑day work challenges confidently, adjusts to multiple demands, shifting priorities, ambiguity and rapid change, and demonstrates resilience.
Sound judgment; makes timely, cost‑effective and sound decisions under uncertainty.
Work commitment; sets high performance standards, pursues goals aggressively and works efficiently.
Commitment to quality; emphasizes delivering quality products/services, defines quality standards, evaluates against them, manages quality and improves efficiencies.
Physical Demands Requires presence at the employee site during regularly scheduled business hours; requires sitting, standing and walking. Requires full range of body motion, handling and lifting patients, manual and finger dexterity, eye‑hand coordination, standing and walking for extensive periods, occasionally lifting up to 40 lb. Requires normal vision and hearing.
Work Environment Environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic. Work requires in‑person interaction with coworkers and management and/or clients, and may require minimal travel by automobile.
Seniority level Mid‑Senior level
Employment type Full‑time
Job function Other
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