Remote Oncology Insurance Verifier

The US Oncology Network; Norfolk (VA); On-site; USD 31,684 - 35,817; Full time

Benefits offered by this job

Medical, Dental, Vision

Life Insurance

401(k)

Job summary

The US Oncology Network is seeking a remote, full-time Insurance Verification Specialist to ensure timely reimbursement for chemotherapy treatments. You will review patient regimens for medical necessity, obtain pre-certifications, and liaise with payers and clinical staff to address coverage issues.

Responsibilities include updating payer guidelines, researching alternative resources, and supporting compliance with HIPAA and insurance policies in a fast-paced oncology setting.

Qualifications

• High school diploma or equivalent.
• Associates degree in Healthcare, LPN license and registration preferred.
• Minimum three (3) years medical insurance verification and authorization 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.
• Updates coding/payer guidelines for clinical staff.
• Obtains insurance authorization and pre-certification specifically for chemotherapy services.
• Researches additional or alternative resources for non-covered chemotherapy services to prevent payment denials.
• Maintains a good working knowledge of chemotherapy authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization.
• Other duties as requested or assigned.

Skills

Medical insurance verification

Authorization processing

Education

High school diploma or equivalent

Associates degree in Healthcare

LPN license and registration preferred

Job description

The US Oncology Network is seeking a remote, full-time Insurance Verification Specialist to ensure timely reimbursement for chemotherapy treatments. You will review patient regimens for medical necessity, obtain pre-certifications, and liaise with payers and clinical staff to address coverage issues.

Responsibilities include updating payer guidelines, researching alternative resources, and supporting compliance with HIPAA and insurance policies in a fast-paced oncology setting.