Insurance Authorization Specialist

Texas Oncology - Rowlett, TX

Full-time - Mid Level

Rowlett, 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 hybrid remote position supports the Rowlett clinic and requires the candidate to reside in Texas. The specialist will work under general supervision to navigate reimbursement guidelines, communicate with medical staff, and advocate for patients in their interactions with insurance providers.

Responsibilities

• Reviews, processes, and audits the medical necessity for each patient's 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.
• Acts 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, 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 regarding patient records.

Requirements

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

Nice-to-haves

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

Benefits

• Full-time position with a competitive salary.
• Hybrid remote work options.
• Opportunity to work with a leading community oncology provider.