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About the Role
The Insurance Authorization Specialist supports the Oncology Department by reviewing chemotherapy regimens, obtaining pre-certifications, and managing reimbursement processes to ensure patients receive timely care.
Responsibilities
- Review, process, and audit medical necessity for chemotherapy treatments and documentation.
- Communicate with nursing and medical staff regarding insurance plan restrictions and requirements.
- Provide feedback to physicians and management on pathway documentation and payer issues.
- Update coding and payer guidelines for clinical staff.
- Obtain insurance authorization and pre-certification for chemotherapy services.
- Act as a patient advocate and liaison between patients and payers.
- Research alternative resources for non-covered services to prevent payment denials.
- Maintain knowledge of chemotherapy authorization requirements and regulatory guidelines.
- Adhere to confidentiality, state, federal, and HIPAA laws regarding patient records.
Requirements
- High school degree or equivalent.
- Minimum three years of medical insurance verification and authorization experience.
- Additional two years of clinical review experience required for Senior level.
- Ability to be present at the employee site during regularly scheduled business hours.
- Ability to lift and carry items weighing up to 40 lbs.
Skills
- Technical and functional expertise in oncology insurance authorization.
- Adaptability to shifting priorities and rapid change.
- Sound judgment and decision-making under uncertainty.
- Commitment to quality standards and process improvement.
- Strong communication and advocacy skills.
Location
- Austin, Texas
Work Type
- Full-time
- Remote
Experience Level
- Level 1
- Senior Level
Education Level
- High school degree or equivalent
- Associates degree in Healthcare preferred
- LPN state license and registration preferred
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- 401K
- Paid holidays
About the Company
- The US Oncology Network is one of the nation’s largest networks of community-based oncology physicians.
- Texas Oncology is the largest community oncology provider in the country with approximately 530 providers in 280+ sites.
- Supported by McKesson Corporation to advance cancer care science, technology, and quality.