Texas Oncology
Insurance Authorization Specialist at Texas Oncology
The US Oncology Network is seeking an Insurance Authorization Specialist to support the Revenue Cycle Department at Texas Oncology in San Antonio, Texas. This full‑time remote position requires working Monday through Friday from 8:00 a.m. to 5:00 p.m. The role may be offered at Level 1 or Senior level based on candidate experience.
Texas Oncology delivers evidence‑based cancer care to patients throughout Texas, supported by the US Oncology Network and McKesson Corporation.
What Does the Insurance Authorization Specialist Do? Under general supervision, the specialist reviews chemotherapy regimens in accordance with reimbursement guidelines, obtains pre‑certifications and exceptions to prevent reimbursement delays, researches denied services, and supports the US Oncology Compliance Program.
Responsibilities
Review, process, and audit medical necessity for each patient’s chemotherapy treatment and document the regimen relative to pathway adherence.
Communicate with nursing and medical staff to inform them of any restrictions or special requirements per insurance plans and provide prompt feedback regarding payer issues with non‑covered chemotherapy drugs.
Update coding/payer guidelines for clinical staff and track pathways; perform various business office functions as needed.
Obtain insurance authorization and pre‑certification for chemotherapy services and serve as a liaison between patients and payers to address reimbursement questions and avoid insurance delays.
Research additional or alternative resources for non‑covered chemotherapy services to prevent payment denials and provide a contact list for patients and community resources including special programs, drugs, pharmaceutical supplies, and financial resources.
Maintain knowledge of chemotherapy authorization requirements for all payers, state and federal regulatory guidelines, and adhere to confidentiality, HIPAA, and related laws regarding 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 three (3) years medical insurance verification and authorization experience preferred.
Level Senior
Minimum three (3) years medical insurance verification and authorization experience and two (2) years clinical review experience required.
Competencies
Technical and functional expertise; up‑to‑date knowledge and use of expert resources.
Adaptability; handles day‑to‑day work challenges, shifts priorities, and remains resilient in adversity.
Sound judgment; makes timely, cost‑effective, and informed decisions under uncertainty.
Work commitment; sets high performance standards and pursues aggressive goals efficiently.
Commitment to quality; defines and evaluates standards for quality and manages improvements.
Physical Demands The physical demands include regular presence at the employee site during scheduled business hours, sitting or standing, talking, hearing, handling and lifting patients, manual and finger dexterity, eye‑hand coordination, standing and walking for extensive periods, occasionally lifting items up to 40 lb, and corrected vision and hearing to normal range.
Work Environment The work environment may involve exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other conditions common to an oncology/hematology clinic. Interaction with co‑workers, management, and clients is required; occasional minimal travel to automobile office sites may be needed.
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Texas Oncology delivers evidence‑based cancer care to patients throughout Texas, supported by the US Oncology Network and McKesson Corporation.
What Does the Insurance Authorization Specialist Do? Under general supervision, the specialist reviews chemotherapy regimens in accordance with reimbursement guidelines, obtains pre‑certifications and exceptions to prevent reimbursement delays, researches denied services, and supports the US Oncology Compliance Program.
Responsibilities
Review, process, and audit medical necessity for each patient’s chemotherapy treatment and document the regimen relative to pathway adherence.
Communicate with nursing and medical staff to inform them of any restrictions or special requirements per insurance plans and provide prompt feedback regarding payer issues with non‑covered chemotherapy drugs.
Update coding/payer guidelines for clinical staff and track pathways; perform various business office functions as needed.
Obtain insurance authorization and pre‑certification for chemotherapy services and serve as a liaison between patients and payers to address reimbursement questions and avoid insurance delays.
Research additional or alternative resources for non‑covered chemotherapy services to prevent payment denials and provide a contact list for patients and community resources including special programs, drugs, pharmaceutical supplies, and financial resources.
Maintain knowledge of chemotherapy authorization requirements for all payers, state and federal regulatory guidelines, and adhere to confidentiality, HIPAA, and related laws regarding 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 three (3) years medical insurance verification and authorization experience preferred.
Level Senior
Minimum three (3) years medical insurance verification and authorization experience and two (2) years clinical review experience required.
Competencies
Technical and functional expertise; up‑to‑date knowledge and use of expert resources.
Adaptability; handles day‑to‑day work challenges, shifts priorities, and remains resilient in adversity.
Sound judgment; makes timely, cost‑effective, and informed decisions under uncertainty.
Work commitment; sets high performance standards and pursues aggressive goals efficiently.
Commitment to quality; defines and evaluates standards for quality and manages improvements.
Physical Demands The physical demands include regular presence at the employee site during scheduled business hours, sitting or standing, talking, hearing, handling and lifting patients, manual and finger dexterity, eye‑hand coordination, standing and walking for extensive periods, occasionally lifting items up to 40 lb, and corrected vision and hearing to normal range.
Work Environment The work environment may involve exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other conditions common to an oncology/hematology clinic. Interaction with co‑workers, management, and clients is required; occasional minimal travel to automobile office sites may be needed.
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