Maryland Oncology Hematology
Insurance Authorization Specialist
Maryland Oncology Hematology, Round Rock, Texas, us, 78682
Overview of the role
The US Oncology Network is looking for an
Insurance Authorization Specialist
to join our team at Texas Oncology. This full-time
remote
position will support the Oncology Department at our Round Rock, TX clinic. Typical work week is Monday through Friday, 8:00 am – 5:00 pm.
Note from Hiring Manager:
Paid Holidays, Weekends Off, Great Benefits!
Position level:
The Insurance Authorization Specialist will be hired as either Level 1 or Senior 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 remains to make high-quality cancer care accessible to all communities and to help patients fight cancer at home with support from family and friends. We use leading-edge technology and research to deliver care that enables more breakthroughs and victories. Texas Oncology treats half of all Texans diagnosed with cancer annually.
The US Oncology Network is one of the nation’s largest networks of community-based oncology physicians, supported by McKesson Corporation to empower a vibrant and sustainable patient care delivery system.
Join a team that invests in your future. At Texas Oncology, select roles may be eligible for our Long-Term Incentive Plan (LTIP), designed to attract, retain, and reward top talent. The LTIP typically vests over three years and is tied to individual performance and the organization’s success; awards are discretionary and subject to continued employment and the terms of the LTIP document.
What the Insurance Authorization Specialist does Under general supervision, reviews chemotherapy regimens for alignment with reimbursement guidelines. Obtains pre-certifications and exceptions to prevent delays in reimbursement. Researches denied services and identifies 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 documents pathway adherence.
Communicates with nursing and medical staff regarding insurance plan restrictions or requirements; provides feedback to physicians and management on documentation and payer issues with non-covered chemotherapy drugs.
Updates coding/payer guidelines for clinical staff; tracks pathways and performs related business office tasks as needed.
Obtains insurance authorization and pre-certification for chemotherapy services; acts as a patient advocate and liaison between patient and payer to resolve reimbursement questions and prevent delays.
Researches additional resources for non-covered chemotherapy services to prevent denials; provides a contact list for patient resources including programs, drugs, and financial assistance.
Maintains knowledge of chemotherapy authorization requirements for all payers and regulatory guidelines; adheres to confidentiality and HIPAA laws governing patient records.
Other duties as assigned.
Qualifications The ideal candidate will have the following background and experience:
Level 1
High school diploma or equivalent
Associates degree in Healthcare or LPN license/registration preferred
Minimum three (3) years medical insurance verification and authorization preferred
Level Senior
Minimum three (3) years medical insurance verification and authorization and two (2) years clinical review experience required
Competencies
Technical and Functional Experience: up-to-date knowledge of the profession; ability to access and use expert resources
Adaptability: handles changing demands with flexibility and resilience
Judgment: makes timely, cost-effective decisions under uncertainty
Work Commitment: pursues high standards and efficient performance
Quality: focuses on delivering quality service; defines standards and evaluates processes
Physical Demands The role requires being present at the clinic during scheduled hours, with the ability to sit or stand, talk or hear, and perform tasks requiring fine motor skills. May involve lifting up to 40 lbs occasionally and occasional travel by car.
Work Environment The work environment may include exposure to clinical conditions and requires in-person interaction with coworkers and management. Travel to office sites may be required occasionally.
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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 will support the Oncology Department at our Round Rock, TX clinic. Typical work week is Monday through Friday, 8:00 am – 5:00 pm.
Note from Hiring Manager:
Paid Holidays, Weekends Off, Great Benefits!
Position level:
The Insurance Authorization Specialist will be hired as either Level 1 or Senior 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 remains to make high-quality cancer care accessible to all communities and to help patients fight cancer at home with support from family and friends. We use leading-edge technology and research to deliver care that enables more breakthroughs and victories. Texas Oncology treats half of all Texans diagnosed with cancer annually.
The US Oncology Network is one of the nation’s largest networks of community-based oncology physicians, supported by McKesson Corporation to empower a vibrant and sustainable patient care delivery system.
Join a team that invests in your future. At Texas Oncology, select roles may be eligible for our Long-Term Incentive Plan (LTIP), designed to attract, retain, and reward top talent. The LTIP typically vests over three years and is tied to individual performance and the organization’s success; awards are discretionary and subject to continued employment and the terms of the LTIP document.
What the Insurance Authorization Specialist does Under general supervision, reviews chemotherapy regimens for alignment with reimbursement guidelines. Obtains pre-certifications and exceptions to prevent delays in reimbursement. Researches denied services and identifies 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 documents pathway adherence.
Communicates with nursing and medical staff regarding insurance plan restrictions or requirements; provides feedback to physicians and management on documentation and payer issues with non-covered chemotherapy drugs.
Updates coding/payer guidelines for clinical staff; tracks pathways and performs related business office tasks as needed.
Obtains insurance authorization and pre-certification for chemotherapy services; acts as a patient advocate and liaison between patient and payer to resolve reimbursement questions and prevent delays.
Researches additional resources for non-covered chemotherapy services to prevent denials; provides a contact list for patient resources including programs, drugs, and financial assistance.
Maintains knowledge of chemotherapy authorization requirements for all payers and regulatory guidelines; adheres to confidentiality and HIPAA laws governing patient records.
Other duties as assigned.
Qualifications The ideal candidate will have the following background and experience:
Level 1
High school diploma or equivalent
Associates degree in Healthcare or LPN license/registration preferred
Minimum three (3) years medical insurance verification and authorization preferred
Level Senior
Minimum three (3) years medical insurance verification and authorization and two (2) years clinical review experience required
Competencies
Technical and Functional Experience: up-to-date knowledge of the profession; ability to access and use expert resources
Adaptability: handles changing demands with flexibility and resilience
Judgment: makes timely, cost-effective decisions under uncertainty
Work Commitment: pursues high standards and efficient performance
Quality: focuses on delivering quality service; defines standards and evaluates processes
Physical Demands The role requires being present at the clinic during scheduled hours, with the ability to sit or stand, talk or hear, and perform tasks requiring fine motor skills. May involve lifting up to 40 lbs occasionally and occasional travel by car.
Work Environment The work environment may include exposure to clinical conditions and requires in-person interaction with coworkers and management. Travel to office sites may be required occasionally.
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