Remote Oncology Insurance Authorization Specialist

The US Oncology Network; Spring (TX); On-site; USD 52,000 - 80,000; Full time

Job summary

The US Oncology Network is seeking an Insurance Authorization Specialist to join Texas Oncology in The Woodlands, TX. This full-time remote position supports the Chemotherapy Department, coordinating pre-certifications and payer communications to ensure timely treatment approval.

The ideal candidate will have experience in medical insurance verification and authorization, strong knowledge of reimbursement guidelines, and a customer-focused approach.

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.
• 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 feedback to physicians and management regarding pathway documentation issues and payer issues with non-covered chemotherapy drugs.
• Updates coding/payer guidelines for clinical staff and tracks pathways.
• Obtains insurance authorization and pre-certification specifically for chemotherapy services and acts as a liaison between patient and payer.
• Researches resources for non-covered chemotherapy services to prevent payment denials and assists patients with community resources.

Skills

Medical insurance verification

Medical authorization

Payer communications

Education

Associates degree in Healthcare

LPN license

Job description

The US Oncology Network is seeking an Insurance Authorization Specialist to join Texas Oncology in The Woodlands, TX. This full-time remote position supports the Chemotherapy Department, coordinating pre-certifications and payer communications to ensure timely treatment approval.

The ideal candidate will have experience in medical insurance verification and authorization, strong knowledge of reimbursement guidelines, and a customer-focused approach.