Eligibility Specialist II

US Oncology Network-wide Career Opportunities; Richardson (TX); Hybrid; USD 42,000 - 62,000; Full time

Job summary

Texas Oncology, part of the US Oncology Network, is seeking an Eligibility Specialist for a full-time hybrid remote role supporting the Central Business Office. The ideal candidate will analyze and resolve eligibility variances, coordinate referrals and retro-authorizations, and assist with patient financial responsibilities.

The position offers advancement from Level 1 to Sr based on experience, with expectations to support compliance and confidentiality within a community oncology setting.

Qualifications

• High school diploma or equivalent required.
• Associates degree preferred for Level 2 and Sr.
• Proficiency with computer systems and Microsoft Office (Word and Excel) required.

Responsibilities

• Researches and obtain accurate insurance coverage information and updates PMS records.
• Coordinate referrals and retro-authorizations where applicable.
• Assist with patient eligibility and financial responsibility assessments.
• Identify uninsured patients and refer to patient benefit representatives.
• Document payor conversations in the PMS and escalate issues as needed.
• Maintain confidentiality and HIPAA compliance.

Skills

MS Office

computer systems

Education

High school diploma

Associates degree preferred

Job description

Overview

The US Oncology Network is looking for a Eligibility Specialist to join our team at Texas Oncology! This full time hybrid remote position will support our Central Business Office location. Additionally, it is desired that the candidate reside within a commutable distance to the Central Business Office location.

This position can be either a level 1, 2 or Sr based on candidate experience.

As a part of The US Oncology Network, Texas Oncology delivers high-quality, evidence-based care to patients close to home. Texas Oncology is the largest community oncology provider in the country and has approximately 530 providers in 280+ sites across Texas, our founders pioneered community-based cancer care because they believed in making the best available cancer care accessible to all communities, allowing people to fight cancer at home with the critical support of family and friends nearby. Our mission is still the same today-at Texas Oncology, we use leading-edge technology and research to deliver high-quality, evidence-based cancer care to help our patients achieve "More breakthroughs. More victories." in their fight against cancer. Today, Texas Oncology treats half of all Texans diagnosed with cancer on an annual basis.

The US Oncology Network is one of the nation's largest networks of community-based oncology physicians dedicated to advancing cancer care in America. The US Oncology Network is supported by McKesson Corporation focused on empowering a vibrant and sustainable community patient care delivery system to advance the science, technology, and quality of care.

What does the Eligibility Specialist do?

Under direct supervision, is responsible for the successful resubmission of invoices to the responsible party. Analyzes and resolves eligibility variances via web research and/or direct contact with patients. Coordinates the activities for the acquisition of referrals and retro-authorizations, where applicable. Follows standard procedures and pre-established guidelines to complete tasks. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards, and US Oncology's Shared Values.

Responsibilities

• Researches and obtain accurate and current insurance coverage information, makes corresponding corrections in the PMS.
• May evaluate benefits and eligibility to assess patient financial responsibility.
• May coordinates referral from primary care clinic to ensure appropriate authorizations are secured and entered into the PMS.
• Identifies uninsured patients and refers to patient benefit representative for coordination of payment.
• Communicates system issues and/or payor trends lead or supervisor.
• May answer questions and resolve complaints.
• Documents conversations with payors in the PMS.
• Contacts and follows up with clinic or any missing or incomplete documentation.
• Works TES Edits.
• Researches and responds to routine account inquiries and takes appropriate action; escalates non-routine issues.
• Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patient's records and collections.
• Other duties as requested or assigned.

Qualifications

The ideal candidate for the position will have the following background and experience:

Level 1

• High school diploma or equivalent required.
• Position is entry level and requires zero (0) to two (2) years with front desk, registrations, healthcare benefits or equivalent experience.
• Proficiency with computer systems and Microsoft Office (Word and Excel) required.

Level 2 (in addition to level 1 requirements)

• High school diploma or equivalent required. Associates degree preferred.
• Position requires three (3) years with front desk, registrations, healthcare benefits or equivalent experience.
• Proficiency with computer systems and Microsoft Office (Word and Excel) required.

Level Sr (in addition to level 1 and 2 requirements)

• High school diploma or equivalent required. Associates degree preferred.
• Position requires four (4) years with front desk, registrations, healthcare benefits or equivalent experience.
• Proficiency with computer systems and Microsoft Office (Word and Excel) required.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be offered to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.

Work Environment

The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites.