Insurance Authorization Specialist

Insurance Authorization Specialist

Apply for the Insurance Authorization Specialist role at The US Oncology Network
.

This full‑time remote position supports the Revenue Cycle Department at Texas Oncology. The job can be performed remotely, with a typical work week from Monday through Friday, 8:00 a.m. to 5:00 p.m. In Texas Oncology, the position is located at 100 NE Loop 410 #600, San Antonio, Texas.

The role accommodates candidates at a Level 1 or Level Sr based on experience.

Under general supervision, the specialist reviews chemotherapy regimens to ensure compliance with reimbursement guidelines, obtains pre‑certifications and exceptions, researches denied services and seeks alternative resources, and supports the US Oncology Compliance Program, including the Code of Ethics and Business Standards.

• Review, process and audit the medical necessity for each patient’s chemotherapy treatment, documenting regimen relative to pathway adherence.
• Communicate with nursing and medical staff about restrictions or special requirements for particular insurance plans, and provide prompt feedback to physicians and management regarding pathway documentation issues and payer issues with non‑covered chemotherapy drugs.
• Update coding/payer guidelines for clinical staff and track pathways; perform other office functions as needed.
• Obtain insurance authorization and pre‑certification for chemotherapy services, act as patient advocate and liaison between patient and payer to answer reimbursement questions and avoid delays.
• Research additional or alternative resources for non‑covered chemotherapy services to prevent payment denials, and provide a contact list for patients’ community resources including special programs, drugs, pharmaceutical supplies and financial resources.
• Maintain a current knowledge of chemotherapy authorization requirements for all payers, state and federal regulatory guidelines, and confidentiality, HIPAA laws and guidelines relating to patient records.
• Perform other duties as requested or assigned.

Level 1

• High school degree or equivalent.
• Associate’s degree in Healthcare, LPN state license and registration preferred.
• Minimum three (3) years of medical insurance verification and authorization preferred.

Level Sr (in addition to Level 1 requirements)

• Minimum three (3) years of medical insurance verification and authorization and two (2) years of clinical review experience required.

Competencies

• Technical and functional expertise, ability to access and use other expert resources.
• Adaptability, ability to handle day‑to‑day work challenges and adjust to multiple demands.
• Sound judgment, decision‑making under uncertainty.
• Work commitment, setting high standards and pursuing goals efficiently.
• Commitment to quality, improving efficiencies. Physical Demands

  The employee must be present at the employee site during regularly scheduled business hours and regularly required to sit or stand, talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, eye‑hand coordination, standing and walking for extensive periods. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.

  Work
  
  Environment

  The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other conditions common to an oncology/hematology clinic environment. Work involves in‑person interaction with co‑workers, management and/or clients and may require minimal travel by automobile to office sites.

  Seniority level
  • Mid‑Senior level
  Employment type
  • Full‑time
  Job function
  • Other
  Industries
  • Hospitals and Health Care