Imaging Authorizations Clinical Reviewer

The US Oncology Network is looking for an Clinical Insurance Reviewer to join our team at Texas Oncology
. This full-time remote position will support the Diagnostic Imaging Department at our 500 South Henderson Suite 400 clinic in Fort Worth, Texas. Typical work week is Monday through Friday, 8:00a - 5:00p.
Must currently reside in Texas.

Note from Hiring Manager
:
This role handles obtaining authorizations for diagnostic imaging across the state of Texas. We are a centralized team of dedicated reviewers who work well together, are in a relaxed environment, and work to ensure each person has the tools and resources necessary to be successful.

This position will be either a level 1 or Sr based on candidate work experience.

As a part of US Oncology Network
, Texas Oncology delivers high-quality, evidence-based care to patients close to home.
Texas Oncology is the largest community oncology provider in the country and has approximately 530 providers in 280+ sites across Texas, our founders pioneered community-based cancer care because they believed in making the best available cancer care accessible to all communities, allowing people to fight cancer at home with the critical support of family and friends nearby. Our mission is still the same today—at Texas Oncology, we use leading-edge technology and research to deliver high-quality, evidence-based cancer care to help our patients achieve "More breakthroughs.

More victories." in their fight against cancer. Today,
Texas Oncology treats half of all Texans diagnosed with cancer on an annual basis.

US Oncology Network is one of the nation's largest networks of community-based oncology physicians dedicated to advancing cancer care in America.
US Oncology Network is supported by Mc Kesson Corporation focused on empowering a vibrant and sustainable community patient care delivery system to advance the science, technology, and quality of care.

Under general supervision, reviews in accordance to reimbursement guidelines. Obtains necessary pre-certifications and exceptions to ensure no delay in reimbursement. Researches denied services. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards.

The essential duties and responsibilities (including but not limited to):

• Reviews, processes and audits the medical necessity for each patient.
• 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 documentation issues, and payer issues.
• Updates coding/payer guidelines for clinical staff.
• Obtains insurance authorization and pre-certification for services. Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
• Maintains a good working knowledge of authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization. Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patient
  * s records.
• Other duties as requested or assigned.

The ideal candidate for the Insurance Reviewer position will have the following background and experience:

• 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.

• Uses Technical and Functional
  
  Experience:
  
  Possesses up to date knowledge of the profession and industry; is regarded as an expert in the technical/functional area; accesses and uses other expert resources when appropriate.
• Demonstrates Adaptability:
  Handles day to day work challenges confidently; is willing and able to adjust to multiple demands, shifting priorities, ambiguity and rapid change; shows resilience inn the face of constraints, frustrations, or adversity; demonstrates flexibility.
• Uses Sound Judgment:
  Makes timely, cost effective and sound decisions; makes decisions under conditions of uncertainty.
• Shows Work Commitment:
  Sets high standards of performance; pursues aggressive goals and works…