Maryland Oncology Hematology
Insurance Authorization Specialist Sr
Maryland Oncology Hematology, Richardson, Texas, United States, 75080
Insurance Authorization Specialist Sr
– Remote full‑time position at Texas Oncology, Richardson, TX.
Overview The US Oncology Network is looking for an Insurance Authorization Specialist to support the Chemotherapy, Radiation, Imaging and Genetics Departments at our 3001 E. President George Bush Hwy Suite 100 location in Richardson, Texas. This full‑time remote position supports a typical work week Monday through Friday, 8:00 a.m. – 4:30 p.m. The role may be Level 1 or Senior based on candidate experience. The position is part of The US Oncology Network, Texas Oncology’s mission to deliver high‑quality, evidence‑based cancer care to patients close to home.
Under general supervision, the specialist reviews chemotherapy regimens according to reimbursement guidelines, obtains pre‑certifications and exceptions to prevent reimbursement delays, researches denied services and identifies alternative funding resources, and supports compliance with the US Oncology Compliance Program.
Responsibilities
Reviews, processes and audits the medical necessity for each patient chemotherapy treatment and documents 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; tracks pathways and performs various other business office functions on an as‑needed basis.
Obtains insurance authorization and pre‑certification specifically for chemotherapy services. Acts 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. 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. 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 degree in Healthcare, LPN state license and registration preferred.
Minimum of three (3) years medical insurance verification and authorization preferred.
Level Sr
Minimum of 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 and uses 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; 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 and talk or hear. 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.
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– Remote full‑time position at Texas Oncology, Richardson, TX.
Overview The US Oncology Network is looking for an Insurance Authorization Specialist to support the Chemotherapy, Radiation, Imaging and Genetics Departments at our 3001 E. President George Bush Hwy Suite 100 location in Richardson, Texas. This full‑time remote position supports a typical work week Monday through Friday, 8:00 a.m. – 4:30 p.m. The role may be Level 1 or Senior based on candidate experience. The position is part of The US Oncology Network, Texas Oncology’s mission to deliver high‑quality, evidence‑based cancer care to patients close to home.
Under general supervision, the specialist reviews chemotherapy regimens according to reimbursement guidelines, obtains pre‑certifications and exceptions to prevent reimbursement delays, researches denied services and identifies alternative funding resources, and supports compliance with the US Oncology Compliance Program.
Responsibilities
Reviews, processes and audits the medical necessity for each patient chemotherapy treatment and documents 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; tracks pathways and performs various other business office functions on an as‑needed basis.
Obtains insurance authorization and pre‑certification specifically for chemotherapy services. Acts 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. 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. 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 degree in Healthcare, LPN state license and registration preferred.
Minimum of three (3) years medical insurance verification and authorization preferred.
Level Sr
Minimum of 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 and uses 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; 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 and talk or hear. 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.
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