Insurance Authorization Specialist
2 weeks ago
Overview:
The US Oncology Network is looking for an Insurance Authorization Specialist Sr to join our team at Texas Oncology. This full-time on-site position will support The Texas Center for Proton Therapy clinic at 1501 West Royal Lane. Work hours are ideally 8:30am to 5:00pm.
The insurance authorization specialist compiles and interprets medical documentation to obtain authorizations for treatment using insurance portals, faxing, and phones calls to insurance.
Time management will be key in order to manage multiple physician orders each day while maintaining a queue of patients for follow-up.
Cross-train in other departments as time permits.As a 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 founders pioneered community-based cancer care because they believed in making the best available cancer care accessible to all communities, allowing people to fight cancer at home with the critical support of family and friends nearby.
Our mission is still the same today—at Texas Oncology, we use leading-edge technology and research to deliver high-quality, evidence-based cancer care to help our patients achieve "More breakthroughs.
More victories." in their fight against cancer. Today, Texas Oncology treats half of all Texans diagnosed with cancer on an annual basis.
The US Oncology Network is one of the nation's largest networks of community-based oncology physicians dedicated to advancing cancer care in America.
The US Oncology Network is supported by McKesson Corporation focused on empowering a vibrant and sustainable community patient care delivery system to advance the science, technology, and quality of care.
What does the Insurance Authorization Specialist do? (including but not limited to)Under general supervision, reviews proton radiation regimens in accordance with reimbursement guidelines. Obtains necessary pre-certifications, exceptions, review of medical policy guidelines to ensure no delay in reimbursement of treatments. Research denied services and alternative resources to pay for treatment. Schedules peer to peers and prepare appeal letters for physician review. Operates within standard procedures and pre-established guidelines to complete tasks. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards.
Responsibilities:
The essential duties and responsibilities (including but not limited to)
Reviews processes and audits the medical necessity for each patient's treatment and documentation of regimen.
Communicates with physicians and medical staff to inform them of any restrictions or special requirements in accordance with insurance plans.
Updates coding/payer guidelines for clinical staff. Tracks and performs various other business office functions on an as needed basis.
Obtains insurance authorization and pre-certification specifically for proton radiation therapy.
Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
Maintains a good working knowledge of proton radiation therapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization.
Other duties as requested or assigned.
Qualifications:
The ideal candidate for the Insurance Authorization Specialist position will have the following background and experience:
High school degree or equivalent.
Minimum three (3) years medical insurance verification and authorization and two (2) years clinical review experience required.
CMA certification highly desired.
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; is willing and able to adjust to multiple demands, shifting priorities, ambiguity and rapid change; shows resilience inn 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 evaluated 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.
While performing the duties of this job, 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 preparation and other conditions common to an oncology clinic environment.
This is an onsite position with hours from 8:30 am - 5:00 pm located in Irving TX .
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