Oncology Insurance Authorization Specialist

The US Oncology Network; Norfolk (VA); On-site; USD 50,000 - 65,000; Full time

Job summary

The US Oncology Network is seeking an Insurance Verification Specialist to review chemotherapy regimens for medical necessity, obtain pre-certifications, and serve as a liaison between patients, physicians, and payers. You will ensure timely reimbursements while maintaining HIPAA compliance and quality service.

The role requires a high school diploma or equivalent, an Associate degree in Healthcare, and an LPN license preferred, with a minimum of three years in medical insurance verification and

Qualifications

• Requires understanding of medical insurance verification and authorization processes.
• Ability to communicate with clinical staff and payers.
• Familiarity with confidentiality and HIPAA guidelines.

Responsibilities

• Reviews, processes and audits medical necessity for chemotherapy regimens and documents pathway adherence.
• Communicates with nursing and medical staff regarding restrictions and payer issues for non-covered drugs.
• Updates coding/payer guidelines for clinical staff and tracks pathways; performs related business office tasks as needed.
• Obtains insurance authorization and pre-certification for chemotherapy services; acts as liaison between patient and payer.
• Researches additional resources for non-covered chemotherapy services and provides patient resources lists.

Skills

Technical proficiency

Adaptability

Sound judgment

Work commitment

Quality focus

Education

Associates degree in Healthcare

LPN license and registration

Job description

The US Oncology Network is seeking an Insurance Verification Specialist to review chemotherapy regimens for medical necessity, obtain pre-certifications, and serve as a liaison between patients, physicians, and payers. You will ensure timely reimbursements while maintaining HIPAA compliance and quality service.

The role requires a high school diploma or equivalent, an Associate degree in Healthcare, and an LPN license preferred, with a minimum of three years in medical insurance verification and