Texas Oncology
Overview
Texas Oncology, part of the US Oncology Network, is hiring an Insurance Authorization Specialist for our 1501 W. Royal Lane clinic in Irving, Texas. This full‑time hybrid position supports Proton Radiation and Chemo Regimens. The typical work week is Monday through Friday, 8:00 a.m. – 4:30 p.m. The role may be level 1 or senior based on candidate work 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 Sr
Minimum three (3) years medical insurance verification and authorization.
Two (2) years clinical review experience required.
Competencies
Technical and functional expertise: possess up‑to‑date knowledge of the profession and industry; regarded as an expert in the technical/functional area; access and use other expert resources when appropriate.
Adaptability: handle day‑to‑day work challenges confidently; willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change; demonstrate resilience in the face of constraints, frustrations, or adversity; show flexibility.
Sound judgment: make timely, cost‑effective and sound decisions; make decisions under conditions of uncertainty.
Work commitment: set high standards of performance; pursue aggressive goals and work efficiently to achieve them.
Commit to quality: emphasize the need to deliver quality products and/or services; define standards for quality and evaluate products, processes, and service against those standards; manage quality; improve 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 is 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 lb. 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.
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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 Sr
Minimum three (3) years medical insurance verification and authorization.
Two (2) years clinical review experience required.
Competencies
Technical and functional expertise: possess up‑to‑date knowledge of the profession and industry; regarded as an expert in the technical/functional area; access and use other expert resources when appropriate.
Adaptability: handle day‑to‑day work challenges confidently; willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change; demonstrate resilience in the face of constraints, frustrations, or adversity; show flexibility.
Sound judgment: make timely, cost‑effective and sound decisions; make decisions under conditions of uncertainty.
Work commitment: set high standards of performance; pursue aggressive goals and work efficiently to achieve them.
Commit to quality: emphasize the need to deliver quality products and/or services; define standards for quality and evaluate products, processes, and service against those standards; manage quality; improve 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 is 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 lb. 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.
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