Remote Oncology Insurance Authorization Specialist

Texas Oncology; Denton (TX); Remote; USD 55,000 - 70,000; Full time

Job summary

Texas Oncology is seeking an Insurance Authorization Specialist to join the Medical Authorizations Department. This full-time, remote role supports chemotherapy payment workflows and ensures timely pre-certifications for treatments at our Denton clinic.

The successful candidate will review medical necessity, communicate with nursing and medical staff, maintain payer guidelines, and advocate for patients while navigating insurance processes across plans and payers.

Qualifications

• High school diploma or equivalent.
• Associates degree in Healthcare preferred.
• Three years of medical insurance verification and authorization experience.

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.
• 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 liaison between patient and payer to answer reimbursement questions and avoid delays.
• Researches additional or alternative resources for non-covered chemotherapy services to prevent payment denials and provides patient resources.

Skills

Medical insurance verification

Authorization processes

Healthcare documentation

Education

Associates degree in Healthcare

LPN license and registration (preferred)

Job description

Texas Oncology is seeking an Insurance Authorization Specialist to join the Medical Authorizations Department. This full-time, remote role supports chemotherapy payment workflows and ensures timely pre-certifications for treatments at our Denton clinic.

The successful candidate will review medical necessity, communicate with nursing and medical staff, maintain payer guidelines, and advocate for patients while navigating insurance processes across plans and payers.