Insurance Authorization Coordinator

4 weeks ago

Longview Texas, United States Texas Oncology Full time
Overview

The US Oncology Network is seeking a highly skilled Insurance Authorization Specialist to support our team at Texas Oncology. This full-time remote position will be based at our Longview clinic, located at 1300 North 4th Street. The ideal candidate will reside within Texas and possess a strong background in medical insurance verification and authorization.

Responsibilities
  • Review and process medical necessity for each patient 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.
  • Associates degree in Healthcare, LPN state license and registration preferred.
  • Minimum three (3) years medical insurance verification and authorization experience, with Level Sr requiring an additional two (2) years of clinical review experience.
Competencies
  • Uses Technical and Functional Experience: Possesses up-to-date knowledge of the profession and industry, accessing and using other expert resources when appropriate.
  • Demonstrates Adaptability: Handles day-to-day work challenges confidently, willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change.
  • Uses Sound Judgment: Makes timely, cost-effective, and sound decisions, making decisions under conditions of uncertainty.
  • Shows Work Commitment: Sets high standards of performance, pursuing aggressive goals and working efficiently to achieve them.
  • Commits to Quality: Emphasizes the need to deliver quality products and/or services, defining standards for quality and evaluating products, processes, and service against those standards, managing quality, and improving efficiencies.

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