Maryland Oncology Hematology
Insurance Authorization Specialist
Maryland Oncology Hematology, Irving, Texas, United States, 75084
Overview
US Oncology Network is looking for an Insurance Authorization Specialist to join our team at Texas Oncology. This full‑time hybrid position supports Proton Radiation and Chemo Regimens at the 1501 W. Royal Lane clinic in Irving, Texas. Typical work week is Monday‑Friday, 8:00 a.m.‑4:30 p.m. The level is either Level 1 or Senior based on experience.
Responsibilities
Review, process, and audit medical necessity documentation for proton beam radiation therapy and select chemotherapy regimens.
Coordinate peer‑to‑peer reviews and prepare appeal letters for denied insurance cases.
Obtain insurance authorizations and pre‑certifications specifically for proton radiation treatments and select chemotherapy regimens.
Serve as a patient advocate and liaison between patients and insurance payers to address reimbursement inquiries and prevent treatment delays.
Educate patients on the authorization process, including peer‑to‑peer reviews and appeals.
Maintain current knowledge of authorization requirements across all payers, as well as state and federal regulations related to coverage and authorization.
Ensure strict compliance with confidentiality standards, including HIPAA and other state and federal patient privacy regulations.
Perform additional duties as 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
Minimum three (3) years medical insurance verification and authorization and two (2) years clinical review experience required.
Competencies
Uses Technical and Functional Experience: up‑to‑date knowledge of the profession and industry; expert in technical/functional area.
Demonstrates Adaptability: handles day‑to‑day challenges confidently; adjusts to shifting priorities and rapid change.
Uses Sound Judgment: makes timely, cost‑effective decisions under uncertainty.
Shows Work Commitment: sets high standards and works efficiently to achieve aggressive goals.
Commits to Quality: emphasizes delivery of quality products and services; manages quality and improves efficiencies.
Physical Demands Employees are required to sit or stand during regularly scheduled business hours, handle and lift patients, and perform manual and finger dexterity tasks. Reasonable accommodations may be made for individuals with disabilities.
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 involves in‑person interaction with co‑workers, management, and clients.
Seniority level: Mid‑Senior level.
Employment type: Full‑time.
Job function: Other.
Industry: Hospitals and Health Care.
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Responsibilities
Review, process, and audit medical necessity documentation for proton beam radiation therapy and select chemotherapy regimens.
Coordinate peer‑to‑peer reviews and prepare appeal letters for denied insurance cases.
Obtain insurance authorizations and pre‑certifications specifically for proton radiation treatments and select chemotherapy regimens.
Serve as a patient advocate and liaison between patients and insurance payers to address reimbursement inquiries and prevent treatment delays.
Educate patients on the authorization process, including peer‑to‑peer reviews and appeals.
Maintain current knowledge of authorization requirements across all payers, as well as state and federal regulations related to coverage and authorization.
Ensure strict compliance with confidentiality standards, including HIPAA and other state and federal patient privacy regulations.
Perform additional duties as 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
Minimum three (3) years medical insurance verification and authorization and two (2) years clinical review experience required.
Competencies
Uses Technical and Functional Experience: up‑to‑date knowledge of the profession and industry; expert in technical/functional area.
Demonstrates Adaptability: handles day‑to‑day challenges confidently; adjusts to shifting priorities and rapid change.
Uses Sound Judgment: makes timely, cost‑effective decisions under uncertainty.
Shows Work Commitment: sets high standards and works efficiently to achieve aggressive goals.
Commits to Quality: emphasizes delivery of quality products and services; manages quality and improves efficiencies.
Physical Demands Employees are required to sit or stand during regularly scheduled business hours, handle and lift patients, and perform manual and finger dexterity tasks. Reasonable accommodations may be made for individuals with disabilities.
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 involves in‑person interaction with co‑workers, management, and clients.
Seniority level: Mid‑Senior level.
Employment type: Full‑time.
Job function: Other.
Industry: Hospitals and Health Care.
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