The US Oncology Network
Insurance Authorization Specialist
The US Oncology Network, San Antonio, Texas, United States, 78208
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 Referral Coordinator Department at our 100 NE Loop 410 Suite 600 location in San Antonio, Texas. Typical work week is Monday through Friday, 8:00a - 5:00p. This position will be either a Level 1 or Senior based on candidate work experience. As part of The US Oncology Network, Texas Oncology delivers high-quality, evidence-based care to patients close to home. Texas Oncology is the largest community oncology provider in the country and has approximately 530 providers in 280+ sites across Texas. Our mission is to provide access to high-quality cancer care with the support of family and friends nearby. The US Oncology Network is one of the nation’s largest networks of community-based oncology physicians. The US Oncology Network is supported by McKesson Corporation to empower a sustainable community patient care delivery system. What does the Insurance Authorization Specialist do?
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. Responsibilities
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 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 specifically for chemotherapy services. Acts as a patient advocate and liaison between 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 knowledge of chemotherapy authorization requirements for all payers, and regulatory guidelines for coverage and authorization. Adheres to confidentiality, state, federal, and HIPAA laws regarding patient records. Other duties as requested or assigned. Qualifications
The ideal candidate will have the following background and experience. Level 1 and Level Senior requirements are listed below. Level 1
High school diploma or equivalent. Associates degree in Healthcare, LPN state license and registration preferred. Minimum three (3) years medical insurance verification and authorization preferred. Level Senior
In addition to Level 1 requirements, minimum three (3) years medical insurance verification and authorization and two (2) years clinical review experience required. Competencies
Uses Technical and Functional Experience: stays current with professional knowledge and resources. Demonstrates Adaptability: handles changing demands and priorities with resilience and flexibility. Uses Sound Judgment: makes timely, cost-effective decisions. Shows Work Commitment: maintains high performance standards and efficiency. Commits to Quality: prioritizes quality and continuous improvement. Physical Demands
Standard office/clinic environment. Requires occasional lifting up to 40 lbs, ability to stand/walk, and good vision/hearing with normal range. Reasonable accommodations may be made to enable performance of essential duties. Work Environment
Possible exposure to communicable diseases, toxic substances, and other conditions common to oncology/hematology settings. In-person interaction with staff and clients. Some travel to office sites may be required.
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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 Referral Coordinator Department at our 100 NE Loop 410 Suite 600 location in San Antonio, Texas. Typical work week is Monday through Friday, 8:00a - 5:00p. This position will be either a Level 1 or Senior based on candidate work experience. As part of The US Oncology Network, Texas Oncology delivers high-quality, evidence-based care to patients close to home. Texas Oncology is the largest community oncology provider in the country and has approximately 530 providers in 280+ sites across Texas. Our mission is to provide access to high-quality cancer care with the support of family and friends nearby. The US Oncology Network is one of the nation’s largest networks of community-based oncology physicians. The US Oncology Network is supported by McKesson Corporation to empower a sustainable community patient care delivery system. What does the Insurance Authorization Specialist do?
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. Responsibilities
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 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 specifically for chemotherapy services. Acts as a patient advocate and liaison between 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 knowledge of chemotherapy authorization requirements for all payers, and regulatory guidelines for coverage and authorization. Adheres to confidentiality, state, federal, and HIPAA laws regarding patient records. Other duties as requested or assigned. Qualifications
The ideal candidate will have the following background and experience. Level 1 and Level Senior requirements are listed below. Level 1
High school diploma or equivalent. Associates degree in Healthcare, LPN state license and registration preferred. Minimum three (3) years medical insurance verification and authorization preferred. Level Senior
In addition to Level 1 requirements, minimum three (3) years medical insurance verification and authorization and two (2) years clinical review experience required. Competencies
Uses Technical and Functional Experience: stays current with professional knowledge and resources. Demonstrates Adaptability: handles changing demands and priorities with resilience and flexibility. Uses Sound Judgment: makes timely, cost-effective decisions. Shows Work Commitment: maintains high performance standards and efficiency. Commits to Quality: prioritizes quality and continuous improvement. Physical Demands
Standard office/clinic environment. Requires occasional lifting up to 40 lbs, ability to stand/walk, and good vision/hearing with normal range. Reasonable accommodations may be made to enable performance of essential duties. Work Environment
Possible exposure to communicable diseases, toxic substances, and other conditions common to oncology/hematology settings. In-person interaction with staff and clients. Some travel to office sites may be required.
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