Maryland Oncology Hematology
Insurance Authorization Specialist Lead
Maryland Oncology Hematology, Richardson, Texas, United States, 75080
Overview
Texas Oncology
is looking for an
Insurance Authorization Specialist – Team Lead
to join our team at
Texas Oncology . This full‑time remote position supports the
Chemotherapy, Radiation, Imaging and Genetics Departments
at our Richardson, Texas location. Typical work week is Monday through Friday, 8:00 a – 4:30 p. Responsibilities
Review, process and audit the medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence. Communicate with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans. Provide prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non‑covered chemotherapy drugs. Update coding/payer guidelines for clinical staff. Track pathways and perform various other business office functions on an as needed basis. Obtain insurance authorization and pre‑certification specifically for chemotherapy services. Act as patient advocate and liaison between the patient and payer to answer reimbursement questions and avoid insurance delays. Research additional or alternative resources for non‑covered chemotherapy services to prevent payment denials. Provide a contact list for patients community resources including special programs, drugs and pharmaceutical supplies and financial resources. Maintain a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization. Adhere to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patient records. Other duties as requested or assigned. Qualifications
Level 1 High school diploma or equivalent required. Associate degree in Finance, Business or four years revenue cycle experience preferred. Minimum two (2) years insurance resolution experience resolving issues with patients and payors as well as four (4) years combined automated medical billing and payment experience required. Proficiency with computer systems and Microsoft Office (Word and Excel) required. Demonstrate knowledge of oncology medical coding required. Demonstrate knowledge of medical billing, payment, financial aid, insurance, and payor processes and procedures. Demonstrate knowledge of state, federal, and third party claims processing required. Demonstrate knowledge of state and federal collections guidelines required. Must successfully complete required e‑learning courses within 90 days of occupying position. Competencies
Uses Technical and Functional Experience: Possesses up‑to‑date knowledge of the profession and industry; is regarded as an expert in the technical/functional area; accesses and uses other expert resources when appropriate. Demonstrates Adaptability: 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. 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; 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 requires sitting or standing and talking or hearing. Requires full range of body motion including handling and lifting patients, 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. Work may require minimal travel by automobile to office sites. Seniority level
Mid‑Senior level Employment type
Full‑time Job function
Other Industries
Hospitals and Health Care
#J-18808-Ljbffr
Texas Oncology
is looking for an
Insurance Authorization Specialist – Team Lead
to join our team at
Texas Oncology . This full‑time remote position supports the
Chemotherapy, Radiation, Imaging and Genetics Departments
at our Richardson, Texas location. Typical work week is Monday through Friday, 8:00 a – 4:30 p. Responsibilities
Review, process and audit the medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence. Communicate with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans. Provide prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non‑covered chemotherapy drugs. Update coding/payer guidelines for clinical staff. Track pathways and perform various other business office functions on an as needed basis. Obtain insurance authorization and pre‑certification specifically for chemotherapy services. Act as patient advocate and liaison between the patient and payer to answer reimbursement questions and avoid insurance delays. Research additional or alternative resources for non‑covered chemotherapy services to prevent payment denials. Provide a contact list for patients community resources including special programs, drugs and pharmaceutical supplies and financial resources. Maintain a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization. Adhere to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patient records. Other duties as requested or assigned. Qualifications
Level 1 High school diploma or equivalent required. Associate degree in Finance, Business or four years revenue cycle experience preferred. Minimum two (2) years insurance resolution experience resolving issues with patients and payors as well as four (4) years combined automated medical billing and payment experience required. Proficiency with computer systems and Microsoft Office (Word and Excel) required. Demonstrate knowledge of oncology medical coding required. Demonstrate knowledge of medical billing, payment, financial aid, insurance, and payor processes and procedures. Demonstrate knowledge of state, federal, and third party claims processing required. Demonstrate knowledge of state and federal collections guidelines required. Must successfully complete required e‑learning courses within 90 days of occupying position. Competencies
Uses Technical and Functional Experience: Possesses up‑to‑date knowledge of the profession and industry; is regarded as an expert in the technical/functional area; accesses and uses other expert resources when appropriate. Demonstrates Adaptability: 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. 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; 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 requires sitting or standing and talking or hearing. Requires full range of body motion including handling and lifting patients, 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. Work may require minimal travel by automobile to office sites. Seniority level
Mid‑Senior level Employment type
Full‑time Job function
Other Industries
Hospitals and Health Care
#J-18808-Ljbffr