Remote Oncology Insurance Authorization Specialist

US Oncology Network-wide Career Opportunities; Odessa (TX); Remote; USD 44,000 - 64,000; Full time

Job summary

The US Oncology Network is seeking an Insurance Authorization Specialist to support the Texas Oncology Laboratory Department in Odessa, TX. This full-time remote role includes reviewing chemotherapy regimens, obtaining pre-certifications, and resolving payer issues to prevent reimbursement delays.

The candidate should have experience in medical insurance verification and authorization, with Sr level requiring additional clinical review experience. Typical hours are Mon-Fri, 8:00am-5:00pm.

Qualifications

• High school degree or equivalent.
• Associates degree in Healthcare, LPN state license and registration preferred.
• Minimum three (3) years medical insurance verification and authorization preferred.
• Level Sr: minimum three (3) years medical insurance verification and authorization and two (2) years clinical review experience required.

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.
• 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. Works as a patient advocate and liaison between the patient and payer to answer reimbursement questions and avoid delays.

Skills

Medical insurance verification

Authorization

Clinical review

High school diploma

Education

High school diploma

Associates degree in Healthcare

LPN license

Job description

The US Oncology Network is seeking an Insurance Authorization Specialist to support the Texas Oncology Laboratory Department in Odessa, TX. This full-time remote role includes reviewing chemotherapy regimens, obtaining pre-certifications, and resolving payer issues to prevent reimbursement delays.

The candidate should have experience in medical insurance verification and authorization, with Sr level requiring additional clinical review experience. Typical hours are Mon-Fri, 8:00am-5:00pm.