Insurance Authorization Specialist

Texas Oncology - The Woodlands, TX

Full-time - Entry Level

Remote - The Woodlands, TX

501-1,000 employees

Hospitals

About the position

The Insurance Authorization Specialist at Texas Oncology plays a crucial role in ensuring timely reimbursement for chemotherapy treatments by reviewing and processing insurance authorizations. This full-time remote position supports the Gulf Coast Regional Office and requires candidates to reside in Texas. The specialist will work closely with medical staff to navigate insurance requirements and advocate for patients, ensuring they receive the necessary treatments without delays.

Responsibilities

• Reviews, processes, and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence.
• Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans.
• Provides prompt feedback to physicians and management regarding pathway documentation issues and payer issues with non-covered chemotherapy drugs.
• Updates coding/payer guidelines for clinical staff.
• Tracks pathways and performs various other business office functions on an as-needed basis.
• Obtains insurance authorization and pre-certification specifically for chemotherapy services.
• Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
• Researches additional or alternative resources for non-covered chemotherapy services to prevent payment denials.
• Provides a contact list for patients' community resources including special programs, drugs and pharmaceutical supplies, and financial resources.
• Maintains a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization.
• Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patient records.

Requirements

• High school degree or equivalent for Level 1; Associate's degree in Healthcare, LPN state license and registration preferred.
• Minimum three (3) years medical insurance verification and authorization preferred for Level 1.
• For Level Sr: Minimum three (3) years medical insurance verification and authorization and two (2) years clinical review experience required.

Nice-to-haves

• Experience in oncology or hematology settings.
• Knowledge of state and federal regulatory guidelines for coverage and authorization.

Benefits

• Remote work flexibility
• Supportive work environment
• Opportunities for professional development