Insurance Authorization Coordinator
2 weeks ago
Position Overview:
Texas Oncology is seeking an Insurance Authorization Coordinator to enhance our Central Business Office operations. This full-time remote role is essential in facilitating the authorization process for chemotherapy treatments, ensuring seamless reimbursement procedures.
Key Responsibilities:
The primary duties include but are not limited to:
- Reviewing and processing chemotherapy treatment plans to verify medical necessity and adherence to reimbursement protocols.
- Collaborating with nursing and medical personnel to communicate any specific requirements or limitations associated with various insurance policies.
- Providing timely updates to physicians and management regarding documentation discrepancies and issues related to non-covered chemotherapy medications.
- Maintaining and updating coding and payer guidelines for clinical staff, while tracking treatment pathways and executing other business office tasks as necessary.
- Securing insurance authorizations and pre-certifications specifically for chemotherapy services, acting as a patient advocate to resolve reimbursement inquiries and prevent delays.
- Researching alternative funding options for non-covered chemotherapy services to mitigate payment denials and offering patients a comprehensive list of community resources, including special programs and financial assistance.
- Upholding a thorough understanding of authorization requirements across all payers, alongside state and federal regulatory standards.
- Ensuring compliance with confidentiality regulations, including state, federal, and HIPAA guidelines regarding patient records.
Qualifications:
The ideal candidate will possess:
- A high school diploma or equivalent; an Associate's degree in Healthcare or a valid LPN state license is preferred.
- A minimum of three (3) years of experience in medical insurance verification and authorization.
Competencies:
Successful candidates will demonstrate:
- Technical expertise and functional knowledge within the healthcare industry.
- Adaptability to manage day-to-day challenges and shifting priorities effectively.
- Sound judgment in decision-making processes, particularly under uncertainty.
- A strong commitment to quality and performance standards.
Physical and Work Environment:
This role may involve exposure to various conditions typical of an oncology/hematology clinic, including communicable diseases and medical preparations. The position requires regular interaction with colleagues and may involve minimal travel to different office sites.
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