Maryland Oncology Hematology
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
Medical Oncology Department
located at 6300 W. Parker Rd., MOB II clinic in Plano, Texas. The typical work week is Monday through Friday, 8:00 a.m. – 4:30 p.m.
Note from Hiring Manager:
You can work from home with a family‑oriented manager.
This position will be either a level 1 or Sr based on candidate work experience.
As 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, serving half of all Texans diagnosed with cancer on an annual basis.
What does the Insurance Authorization Specialist do? Under general supervision, the specialist reviews chemotherapy regimens in accordance with reimbursement guidelines, obtains necessary pre‑certifications and exceptions to ensure no delay in reimbursement, researches denied services and alternative resources to pay for treatment, and supports the US Oncology Compliance Program, including the Code of Ethics and Business Standards.
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, and 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 as needed.
Obtains insurance authorization and pre‑certification specifically for chemotherapy services, acting as a patient advocate and 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, and provides a contact list for patients’ community resources including special programs, drugs, 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, and adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regard to 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 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; 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 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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 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, talk or hear, handle and lift patients, maintain manual and finger dexterity, and utilizes eye‑hand coordination. The employee is required to stand and walk for extensive periods of time and occasionally lift and carry 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 and may require minimal travel by automobile to office sites.
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Insurance Authorization Specialist
to join our team at
Texas Oncology . This full‑time remote position will support the
Medical Oncology Department
located at 6300 W. Parker Rd., MOB II clinic in Plano, Texas. The typical work week is Monday through Friday, 8:00 a.m. – 4:30 p.m.
Note from Hiring Manager:
You can work from home with a family‑oriented manager.
This position will be either a level 1 or Sr based on candidate work experience.
As 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, serving half of all Texans diagnosed with cancer on an annual basis.
What does the Insurance Authorization Specialist do? Under general supervision, the specialist reviews chemotherapy regimens in accordance with reimbursement guidelines, obtains necessary pre‑certifications and exceptions to ensure no delay in reimbursement, researches denied services and alternative resources to pay for treatment, and supports the US Oncology Compliance Program, including the Code of Ethics and Business Standards.
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, and 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 as needed.
Obtains insurance authorization and pre‑certification specifically for chemotherapy services, acting as a patient advocate and 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, and provides a contact list for patients’ community resources including special programs, drugs, 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, and adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regard to 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 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; 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 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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 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, talk or hear, handle and lift patients, maintain manual and finger dexterity, and utilizes eye‑hand coordination. The employee is required to stand and walk for extensive periods of time and occasionally lift and carry 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 and may require minimal travel by automobile to office sites.
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