Insurance Authorization Specialist

2 days ago


Longview Texas, United States Texas Oncology Full time
About the Role

We are seeking a highly skilled Insurance Authorization Specialist to join our team at Texas Oncology. This full-time remote position will support our Longview clinic and will be responsible for ensuring seamless insurance authorization and reimbursement processes for our patients.

Key Responsibilities
  • Review and process medical necessity for each patient's chemotherapy treatment and documentation of regimen relative to pathway adherence.
  • Communicate with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans.
  • Provide prompt feedback to physicians and management regarding pathway documentation issues and payer issues with non-covered chemotherapy drugs.
  • Update coding/payer guidelines for clinical staff and track pathways as needed.
  • Obtain insurance authorization and pre-certification specifically for chemotherapy services.
  • Work as a patient advocate and function as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
  • Research additional or alternative resources for non-covered chemotherapy services to prevent payment denials.
  • Maintain a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization.
Requirements
  • High school degree or equivalent.
  • Associates degree in Healthcare, LPN state license and registration preferred.
  • Minimum three (3) years medical insurance verification and authorization experience.
  • 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.
  • Demonstrates Adaptability: Handles day to day work challenges confidently.
  • Uses Sound Judgment: Makes timely, cost effective and sound decisions.
  • Shows Work Commitment: Sets high standards of performance.
  • Commits to Quality: Emphasizes the need to deliver quality products and/or services.


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