Insurance Authorization Specialist
US Oncology Inc., San Antonio, TX, United States
Overview
The US Oncology Network is looking for an Insurance Authorization Specialist to join the team at Texas Oncology. This full‑time remote position will support the Chemotherapy Department at a location in San Antonio, Texas. The typical work week is Monday through Friday, 8:00 a.m. - 5:00 p.m. The position will be either a Level 1 or Sr level based on candidate work experience.
Responsibilities
Under general supervision, reviews chemotherapy regimens in accordance with reimbursement guidelines. Obtains necessary pre-certifications and exceptions to ensure no delay in reimbursement of treatments. Researches denied services and alternative resources to pay for treatment. Supports and adheres to the US Oncology Compliance Program, including the Code of Ethics and Business Standards.
Reviews, processes and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence.
Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans. Provides prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered chemotherapy drugs.
Updates coding/payer guidelines for clinical staff. Tracks pathways and performs various other business office functions as needed.
Obtains insurance authorization and pre-certification for chemotherapy services. Acts as a patient advocate and liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
Researches additional or alternative resources for non-covered chemotherapy services to prevent payment denials. Provides a contact list for patients community resources including special programs, drugs and pharmaceutical supplies and financial resources.
Maintains a working knowledge of chemotherapy authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization. Adheres to confidentiality, state, federal, and HIPAA laws and guidelines regarding patient records.
Other duties as requested or assigned.
Qualifications
Ideal candidate for the Insurance Authorization Specialist position will have the following background and experience.
Level 1
High school degree or equivalent.
Associate’s degree in Healthcare, LPN state license and registration preferred.
Minimum three (3) years of medical insurance verification and authorization preferred.
Level Sr
Minimum three (3) years of medical insurance verification and authorization and two (2) years of clinical review experience required.
Competencies
Uses technical and functional experience; possesses up-to-date knowledge of the profession and industry, is regarded as an expert, accesses and uses other expert resources when appropriate.
Demonstrates adaptability; handles day-to-day work challenges confidently, is willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change, shows resilience in the face of constraints, frustrations, or adversity, demonstrates flexibility.
Uses sound judgment; makes timely, cost effective and sound decisions; makes decisions under conditions of uncertainty.
Shows work commitment; sets high standards of performance; pursues aggressive goals and works efficiently to achieve them.
Commits to quality; emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluates products, processes, and service against those standards; manages quality; improves 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.
The employee is required to be present at the employee site during regularly scheduled business hours and 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 lbs. 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. Work may require minimal travel by automobile to office sites.
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The US Oncology Network is looking for an Insurance Authorization Specialist to join the team at Texas Oncology. This full‑time remote position will support the Chemotherapy Department at a location in San Antonio, Texas. The typical work week is Monday through Friday, 8:00 a.m. - 5:00 p.m. The position will be either a Level 1 or Sr level based on candidate work experience.
Responsibilities
Under general supervision, reviews chemotherapy regimens in accordance with reimbursement guidelines. Obtains necessary pre-certifications and exceptions to ensure no delay in reimbursement of treatments. Researches denied services and alternative resources to pay for treatment. Supports and adheres to the US Oncology Compliance Program, including the Code of Ethics and Business Standards.
Reviews, processes and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence.
Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans. Provides prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered chemotherapy drugs.
Updates coding/payer guidelines for clinical staff. Tracks pathways and performs various other business office functions as needed.
Obtains insurance authorization and pre-certification for chemotherapy services. Acts as a patient advocate and liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
Researches additional or alternative resources for non-covered chemotherapy services to prevent payment denials. Provides a contact list for patients community resources including special programs, drugs and pharmaceutical supplies and financial resources.
Maintains a working knowledge of chemotherapy authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization. Adheres to confidentiality, state, federal, and HIPAA laws and guidelines regarding patient records.
Other duties as requested or assigned.
Qualifications
Ideal candidate for the Insurance Authorization Specialist position will have the following background and experience.
Level 1
High school degree or equivalent.
Associate’s degree in Healthcare, LPN state license and registration preferred.
Minimum three (3) years of medical insurance verification and authorization preferred.
Level Sr
Minimum three (3) years of medical insurance verification and authorization and two (2) years of clinical review experience required.
Competencies
Uses technical and functional experience; possesses up-to-date knowledge of the profession and industry, is regarded as an expert, accesses and uses other expert resources when appropriate.
Demonstrates adaptability; handles day-to-day work challenges confidently, is willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change, shows resilience in the face of constraints, frustrations, or adversity, demonstrates flexibility.
Uses sound judgment; makes timely, cost effective and sound decisions; makes decisions under conditions of uncertainty.
Shows work commitment; sets high standards of performance; pursues aggressive goals and works efficiently to achieve them.
Commits to quality; emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluates products, processes, and service against those standards; manages quality; improves 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.
The employee is required to be present at the employee site during regularly scheduled business hours and 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 lbs. 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. Work may require minimal travel by automobile to office sites.
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