Insurance Authorization Specialist

The US Oncology Network; San Antonio (TX); Remote; USD 45,000 - 65,000; Full time

Job summary

A leading healthcare organization is seeking an Insurance Authorization Specialist to join their team in San Antonio. This full-time remote position involves reviewing chemotherapy regimens for reimbursement, obtaining pre-certifications, and ensuring compliance with insurance guidelines. Candidates should have relevant experience in medical insurance verification and authorization, with the potential for growth based on qualifications.

Qualifications

• 3+ years of medical insurance verification and authorization experience preferred for Level 1.
• 3+ years of insurance verification and authorization plus 2+ years of clinical review experience for Level Sr.

Responsibilities

• Reviews, processes, and audits medical necessity documentation for chemotherapy treatments.
• Obtains insurance authorization and pre-certification for chemotherapy services.
• Communicates with medical staff regarding insurance restrictions and requirements.

Skills

Technical expertise

Adaptability

Sound judgment

Work commitment

Quality focus

Education

High school diploma or equivalent

Associate's degree or LPN license preferred

Job description

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Overview

The US Oncology Network is looking for an Insurance Authorization Specialist to join our team at Texas Oncology. This full-time remote position will support our San Antonio Central Business Office at 100 NE Loop 410.

This position will be either a level 1 or Sr based on candidate work experience.

As a part of The US Oncology Network, Texas Oncology delivers high-quality, evidence-based care to patients close to home. It is the largest community oncology provider in the country, with approximately 530 providers across 280+ sites in Texas. Our mission is to make cancer care accessible and effective, utilizing leading-edge technology and research.

The US Oncology Network is one of the nation’s largest networks of community-based oncology physicians, supported by McKesson Corporation, dedicated to advancing cancer care in America.

What does the Insurance Authorization Specialist do?

Under general supervision, reviews chemotherapy regimens for reimbursement guidelines, obtains necessary pre-certifications, researches denied services, and supports adherence to compliance standards.

Responsibilities

• Reviews, processes, and audits medical necessity documentation for chemotherapy treatments.
• Communicates with medical staff regarding insurance restrictions and requirements.
• Updates coding and payer guidelines; tracks pathways and performs business office functions.
• Obtains insurance authorization and pre-certification for chemotherapy services.
• Researches resources for non-covered services; provides patient community resource contacts.
• Maintains knowledge of chemotherapy authorization requirements and adheres to confidentiality laws.
• Performs other duties as assigned.

Qualifications

Level 1 requires a high school diploma or equivalent; associates degree or LPN license preferred; 3+ years of medical insurance verification and authorization experience preferred.

Level Sr requires 3+ years of insurance verification and authorization, plus 2+ years of clinical review experience.

Competencies include: technical expertise, adaptability, sound judgment, work commitment, and quality focus.

Physical Demands: includes sitting, standing, lifting up to 40 lbs, and other physical activities.

Work Environment: includes exposure to medical environments, potential travel, and interaction with staff and patients.

Seniority level: Mid-Senior level. Employment type: Full-time. Industry: Hospitals and Health Care.