Insurance Authorization Specialist

3 weeks ago


Longview, Texas, United States US Oncology Network-wide Career Opportunities Full time
Overview

The US Oncology Network is a leading provider of community-based cancer care, delivering high-quality, evidence-based treatments to patients across the country. We are seeking an experienced Insurance Authorization Specialist to join our team at Texas Oncology, a leading cancer treatment center in Longview, Texas.

Responsibilities
  • Review and process medical necessity for each patient's chemotherapy treatment, ensuring adherence to reimbursement guidelines.
  • Communicate with nursing and medical staff to inform them of any restrictions or special requirements for insurance plans.
  • Provide prompt feedback to physicians and management regarding pathway documentation issues and payer issues with non-covered chemotherapy drugs.
  • Update coding and payer guidelines for clinical staff, tracking pathways and performing various business office functions as needed.
  • Obtain insurance authorization and pre-certification for chemotherapy services, working as a patient advocate and 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, providing a contact list for patients with community resources, special programs, drugs, and pharmaceutical supplies, as well as financial resources.
  • Maintain a good working knowledge of chemotherapy authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization, adhering to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patient records.
Qualifications
  • High school degree or equivalent, with an associate's degree in healthcare or LPN state license and registration preferred.
  • Minimum three years of medical insurance verification and authorization experience, with two years of clinical review experience required for the Sr level.
Competencies
  • Uses technical and functional experience, possessing up-to-date knowledge of the profession and industry, and accessing and using other expert resources when appropriate.
  • Demonstrates adaptability, handling day-to-day work challenges confidently, and adjusting to multiple demands, shifting priorities, ambiguity, and rapid change.
  • Uses sound judgment, making timely, cost-effective, and sound decisions, and making decisions under conditions of uncertainty.
  • Shows work commitment, setting high standards of performance, pursuing aggressive goals, and working efficiently to achieve them.
  • Commits to quality, emphasizing the need to deliver quality products and/or services, defining standards for quality, and evaluating products, processes, and service against those standards.


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