The US Oncology Network
Overview
The US Oncology Network is looking for an
Insurance Authorization Specialist
to join Texas Oncology. This full-time remote position will support the Oncology Department at our Round Rock clinic. Typical work week is Monday through Friday, 8:00a - 5:00p. Note from Hiring Manager: Paid Holidays, Weekends Off, Great Benefits! This position will be either a Level 1 or Sr based on candidate work experience. As part of The US Oncology Network, Texas Oncology delivers high-quality, evidence-based cancer care to patients close to home. Texas Oncology is the largest community oncology provider in the country with approximately 530 providers in 280+ sites across Texas. Our mission is to make high-quality cancer care accessible to all communities, helping patients fight cancer at home with support from family and friends. The US Oncology Network is one of the nation’s largest networks of community-based oncology physicians, supported by McKesson Corporation.
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 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 specifically for chemotherapy services. Works as a patient advocate and functions as a 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 good working knowledge of chemotherapy authorization requirements for all payers, and state and federal regulatory guidelines for coverage and authorization. Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patient records. Other duties as requested or assigned. Qualifications
The ideal candidate for the Insurance Authorization Specialist position will have the following background and experience: Level 1
High school degree or equivalent. Associates 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 and two (2) years 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 in the technical/functional area; accesses and uses other expert resources when appropriate. Demonstrates Adaptability: Handles day to day work challenges confidently; adjusts 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: Delivers quality products and/or services; defines standards for quality and evaluates processes and service against those standards; manages quality and 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. While performing the duties of this job, the employee is required to be present at the site during regularly scheduled business hours and to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual dexterity, and eye-hand coordination. Requires standing and walking for extensive periods. 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 involves in-person interaction with co-workers and management and/or clients. Travel to office sites may be required. Details
Seniority level: Mid-Senior level Employment type: Full-time Job function: Other Industries: Hospitals and Health Care
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The US Oncology Network is looking for an
Insurance Authorization Specialist
to join Texas Oncology. This full-time remote position will support the Oncology Department at our Round Rock clinic. Typical work week is Monday through Friday, 8:00a - 5:00p. Note from Hiring Manager: Paid Holidays, Weekends Off, Great Benefits! This position will be either a Level 1 or Sr based on candidate work experience. As part of The US Oncology Network, Texas Oncology delivers high-quality, evidence-based cancer care to patients close to home. Texas Oncology is the largest community oncology provider in the country with approximately 530 providers in 280+ sites across Texas. Our mission is to make high-quality cancer care accessible to all communities, helping patients fight cancer at home with support from family and friends. The US Oncology Network is one of the nation’s largest networks of community-based oncology physicians, supported by McKesson Corporation.
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 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 specifically for chemotherapy services. Works as a patient advocate and functions as a 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 good working knowledge of chemotherapy authorization requirements for all payers, and state and federal regulatory guidelines for coverage and authorization. Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patient records. Other duties as requested or assigned. Qualifications
The ideal candidate for the Insurance Authorization Specialist position will have the following background and experience: Level 1
High school degree or equivalent. Associates 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 and two (2) years 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 in the technical/functional area; accesses and uses other expert resources when appropriate. Demonstrates Adaptability: Handles day to day work challenges confidently; adjusts 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: Delivers quality products and/or services; defines standards for quality and evaluates processes and service against those standards; manages quality and 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. While performing the duties of this job, the employee is required to be present at the site during regularly scheduled business hours and to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual dexterity, and eye-hand coordination. Requires standing and walking for extensive periods. 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 involves in-person interaction with co-workers and management and/or clients. Travel to office sites may be required. Details
Seniority level: Mid-Senior level Employment type: Full-time Job function: Other Industries: Hospitals and Health Care
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