Insurance Authorization Specialist
Texas Oncology, San Antonio, TX, United States
Overview
The US Oncology Network is looking for an Insurance Authorization Specialist to join our team at Texas Oncology. This full‑time remote position supports the Radiation/Radiology Department at our 100 NE Loop 410 #600 location in San Antonio, Texas and will be classified as Level 1 or Senior based on candidate experience. The typical work week is Monday through Friday, 8:00 a.m. – 5:00 p.m.
Responsibilities
Review, process and audit the medical necessity for each patient’s chemotherapy treatment and document regimen relative to pathway adherence.
Communicate with nursing and medical staff to inform them of restrictions or special requirements in accordance with insurance plans, and provide prompt feedback to physicians and management regarding pathway documentation and payer issues.
Update coding and payer guidelines for clinical staff, track pathways, and perform other business‑office functions as needed.
Obtain insurance authorization and pre‑certification specifically for chemotherapy services and act as a patient advocate and liaison between patients and payers to answer reimbursement questions and avoid delays.
Research alternative resources for non‑covered chemotherapy services to prevent payment denials and provide patients with a contact list for community resources, special programs, pharmaceutical supplies, and financial assistance.
Maintain knowledge of chemotherapy authorization requirements for all payers, state and federal regulations, and adhere to confidentiality and HIPAA laws regarding patient records.
Perform 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 3 years of medical insurance verification and authorization experience preferred.
Level Senior
All Level 1 requirements.
Minimum 3 years of medical insurance verification and authorization and 2 years of clinical review experience required.
Competencies
Expertise in the technical/functional area and use of relevant resources.
Adaptability to shifting priorities, ambiguity, and rapid change.
Sound judgment to make timely, cost‑effective decisions under uncertainty.
Commitment to high standards of performance and efficiency.
Focus on quality, defining standards, evaluating products, and improving efficiencies.
Physical Demands
Employees must be present on site during scheduled business hours and may sit or stand, talk or hear. The role requires full range of body motion, handling and lifting patients, manual and finger dexterity, eye‑hand coordination, standing and walking for extensive periods, and occasional lifting of up to 40 lbs. Corrected vision and hearing to normal range are required. Reasonable accommodations may be made.
Work Environment
The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other common conditions in an oncology clinic. The role involves in‑person interaction with coworkers, management, and clients and may require minimal automobile travel to office sites.
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The US Oncology Network is looking for an Insurance Authorization Specialist to join our team at Texas Oncology. This full‑time remote position supports the Radiation/Radiology Department at our 100 NE Loop 410 #600 location in San Antonio, Texas and will be classified as Level 1 or Senior based on candidate experience. The typical work week is Monday through Friday, 8:00 a.m. – 5:00 p.m.
Responsibilities
Review, process and audit the medical necessity for each patient’s chemotherapy treatment and document regimen relative to pathway adherence.
Communicate with nursing and medical staff to inform them of restrictions or special requirements in accordance with insurance plans, and provide prompt feedback to physicians and management regarding pathway documentation and payer issues.
Update coding and payer guidelines for clinical staff, track pathways, and perform other business‑office functions as needed.
Obtain insurance authorization and pre‑certification specifically for chemotherapy services and act as a patient advocate and liaison between patients and payers to answer reimbursement questions and avoid delays.
Research alternative resources for non‑covered chemotherapy services to prevent payment denials and provide patients with a contact list for community resources, special programs, pharmaceutical supplies, and financial assistance.
Maintain knowledge of chemotherapy authorization requirements for all payers, state and federal regulations, and adhere to confidentiality and HIPAA laws regarding patient records.
Perform 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 3 years of medical insurance verification and authorization experience preferred.
Level Senior
All Level 1 requirements.
Minimum 3 years of medical insurance verification and authorization and 2 years of clinical review experience required.
Competencies
Expertise in the technical/functional area and use of relevant resources.
Adaptability to shifting priorities, ambiguity, and rapid change.
Sound judgment to make timely, cost‑effective decisions under uncertainty.
Commitment to high standards of performance and efficiency.
Focus on quality, defining standards, evaluating products, and improving efficiencies.
Physical Demands
Employees must be present on site during scheduled business hours and may sit or stand, talk or hear. The role requires full range of body motion, handling and lifting patients, manual and finger dexterity, eye‑hand coordination, standing and walking for extensive periods, and occasional lifting of up to 40 lbs. Corrected vision and hearing to normal range are required. Reasonable accommodations may be made.
Work Environment
The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other common conditions in an oncology clinic. The role involves in‑person interaction with coworkers, management, and clients and may require minimal automobile travel to office sites.
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