The US Oncology Network
Overview
Insurance Authorization Specialist
at
The US Oncology Network
(Texas Oncology) is a full‑time remote position supporting the Medical Oncology Department at our 6300 W. Parker Rd. MOB II clinic in Plano, Texas. Typical work week: Monday‑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 Level 1 or Senior based on candidate experience.
As part of
The US Oncology Network ,
Texas Oncology
delivers high‑quality, evidence‑based care to patients near home. Texas Oncology is the largest community oncology provider in the country, with approx. 530 providers in 280+ sites across Texas.
Key Responsibilities
Under general supervision, review chemotherapy regimens in accordance with reimbursement guidelines.
Obtain necessary pre‑certifications and exceptions to ensure no delay in reimbursement of treatments.
Research denied services and alternative resources to pay for treatment.
Support and adhere to the US Oncology Compliance Program, including the Code of Ethics and Business Standards.
Review, process, and audit the medical necessity for each patient’s chemotherapy treatment and documentation of regimen relative to pathway adherence.
Communicate with nursing and medical staff to inform them of restrictions or special requirements per 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 as needed.
Obtain insurance authorization and pre‑certification for chemotherapy services; act as patient advocate and liaison between patient and payer.
Research additional or alternative resources for non‑covered chemotherapy services to prevent payment denials; provide contact list for patients’ community resources, special programs, drugs, 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 concerning 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 Senior
(in addition to Level 1 requirements)
Minimum three (3) years medical insurance verification and authorization and two (2) years clinical review experience required.
Competencies
Technical experience and functional knowledge; expert in the area; uses other expert resources when appropriate.
Adaptability; handles day‑to‑day work challenges confidently; willing and able to adjust to multiple demands, shifting priorities, ambiguity and rapid change; demonstrates resilience.
Sound judgment; makes timely, cost‑effective decisions under uncertainty.
Work commitment; sets high standards, pursues aggressive goals, works efficiently.
Commitment to quality; emphasizes quality delivery, defines standards, evaluates processes against them, manages quality, improves efficiencies.
Physical Demands Employees may need to sit or stand, talk or hear, handle and lift patients, perform manual and finger dexterity tasks, sit, stand, walk for extended periods, occasionally lift up to 40 lb, and require corrected vision and hearing. Reasonable accommodations may be provided.
Work Environment Work may involve exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other conditions common to an oncology/hematology clinic. Requires occasional in‑person interaction with co‑workers and clients; might require minimal auto travel.
Seniority Level Mid‑Senior level
Employment Type Full‑time
Job Function Other
Industries Hospitals and Health Care
#J-18808-Ljbffr
at
The US Oncology Network
(Texas Oncology) is a full‑time remote position supporting the Medical Oncology Department at our 6300 W. Parker Rd. MOB II clinic in Plano, Texas. Typical work week: Monday‑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 Level 1 or Senior based on candidate experience.
As part of
The US Oncology Network ,
Texas Oncology
delivers high‑quality, evidence‑based care to patients near home. Texas Oncology is the largest community oncology provider in the country, with approx. 530 providers in 280+ sites across Texas.
Key Responsibilities
Under general supervision, review chemotherapy regimens in accordance with reimbursement guidelines.
Obtain necessary pre‑certifications and exceptions to ensure no delay in reimbursement of treatments.
Research denied services and alternative resources to pay for treatment.
Support and adhere to the US Oncology Compliance Program, including the Code of Ethics and Business Standards.
Review, process, and audit the medical necessity for each patient’s chemotherapy treatment and documentation of regimen relative to pathway adherence.
Communicate with nursing and medical staff to inform them of restrictions or special requirements per 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 as needed.
Obtain insurance authorization and pre‑certification for chemotherapy services; act as patient advocate and liaison between patient and payer.
Research additional or alternative resources for non‑covered chemotherapy services to prevent payment denials; provide contact list for patients’ community resources, special programs, drugs, 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 concerning 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 Senior
(in addition to Level 1 requirements)
Minimum three (3) years medical insurance verification and authorization and two (2) years clinical review experience required.
Competencies
Technical experience and functional knowledge; expert in the area; uses other expert resources when appropriate.
Adaptability; handles day‑to‑day work challenges confidently; willing and able to adjust to multiple demands, shifting priorities, ambiguity and rapid change; demonstrates resilience.
Sound judgment; makes timely, cost‑effective decisions under uncertainty.
Work commitment; sets high standards, pursues aggressive goals, works efficiently.
Commitment to quality; emphasizes quality delivery, defines standards, evaluates processes against them, manages quality, improves efficiencies.
Physical Demands Employees may need to sit or stand, talk or hear, handle and lift patients, perform manual and finger dexterity tasks, sit, stand, walk for extended periods, occasionally lift up to 40 lb, and require corrected vision and hearing. Reasonable accommodations may be provided.
Work Environment Work may involve exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other conditions common to an oncology/hematology clinic. Requires occasional in‑person interaction with co‑workers and clients; might require minimal auto travel.
Seniority Level Mid‑Senior level
Employment Type Full‑time
Job Function Other
Industries Hospitals and Health Care
#J-18808-Ljbffr