The US Oncology Network is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.
Insurance Authorization Specialist Sr
Location
United States
Posted
16 days ago
Salary
0
Seniority
Senior
No structured requirement data.
Job Description
Insurance Authorization Specialist Sr
The US Oncology Network
Role Description The US Oncology Network is looking for an Insurance Authorization Specialist to join our team at Texas Oncology. This full-time remote position will support the Medical Oncology Department at our 10101 Woodlock Forest location in The Woodlands, Texas. Typical work week is Monday through Friday, 8:30a - 5:00p. Note from Hiring Manager: Great working environment with a good team! This position will be either a level 1 or Sr based on candidate work experience. As a part of The US Oncology Network, Texas Oncology delivers high-quality, evidence-based care to patients close to home. What does the Insurance Authorization Specialist do? (including but not limited to) - Under general supervision, reviews chemotherapy regimens in accordance to reimbursement guidelines. - Obtains necessary pre-certifications and exceptions to ensure no delay in reimbursement of treatments. - Researches denied services and alternative resources to pay for treatment. - Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards. 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 prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered chemotherapy drugs. - Updates coding/payer guidelines for clinical staff. - Tracks pathways and performs various other business office functions on an as needed basis. - Obtains insurance authorization and pre-certification specifically for chemotherapy services. - Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays. - Researches additional or alternative resources for non-covered chemotherapy services to prevent payment denials. - Provides a contact list for patients community resources including special programs, drugs and pharmaceutical supplies and financial resources. - Maintains a good working knowledge of chemotherapy 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 records. - Other duties as requested or assigned. Qualifications - Level 1: 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. - Level Sr: Minimum three (3) years medical insurance verification and authorization and two (2) years clinical review experience required. Competencies - 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 in 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 efficiently to achieve them. - Commits to Quality: Emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluates products, processes, and service against those standards; manages quality; improves efficiencies. Physical Demands - The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. - Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. - While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours. - Regularly required to sit or stand and talk or hear. - Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. - Requires standing and walking for extensive periods of time. - 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 will involve in-person interaction with co-workers and management and/or clients. - Work may require minimal travel by automobile to office sites.
Related Guides
Related Categories
Related Job Pages
More Insurance Jobs
• Identify client needs and recommend tailored insurance solutions • Develop and maintain strong client relationships • Generate leads through networking, referrals, and company-provided resources • Educate clients on available policies and coverage options • Follow up with prospects to close sales and maintain customer satisfaction • Stay informed about industry trends and product offerings • Work independently while collaborating with a supportive team
• Identify client needs and recommend tailored insurance solutions • Develop and maintain strong client relationships • Educate clients on policy options and coverage solutions • Stay informed on industry trends and product offerings • Work independently while collaborating with a supportive team • Assist in training and mentoring future agents as you grow into leadership
• Identify client needs and recommend tailored insurance solutions • Develop and maintain strong client relationships • Generate leads through networking, referrals, and company-provided resources • Educate clients on available policies and coverage options • Follow up with prospects to close sales and maintain customer satisfaction • Stay informed about industry trends and product offerings • Work independently while collaborating with a supportive team
Role Description Our client, one of the country's largest owners and operators of multifamily housing, managing high-quality properties in most major markets. We value integrity, respect, collaboration, customer focus, and performance. These values are brought to life by our teammates, who are ultimately responsible for our success. When you join our team, you'll work alongside the most dedicated professionals in the industry and open the door to unlimited career opportunities. Your Main Responsibilities - Perform numerous administrative tasks for Risk Management department. - Assist with processing claims as they first come in. - Assist with reconciling property claims and follow up with questions or incomplete required information related to claims. Resolves issues and troubleshoots as needed. - Assist by looking up purchase orders and invoices to reconcile Catastrophe claims. - Subrogation - look up resident information in Entrata - renters insurance, leases. Gather invoices from Coupa to support our demands to responsible parties that cause damage to our properties. - This person can own some of the processes below once we have them in place (Bonds or Flood tracking). - Update and maintain trackers for written Health and Safety plans for newly acquired properties (each property has required written plans, i.e. Elevated Work Surfaces, Confined Spaces, Lockout Tagout, Asbestos, Liquid Damage (plumbing system breaks), Freeze and Flood). - Data lookup in Entrata for property and General Liability (GL) losses (leases, activity notes, service requests reports, etc.). - Enter and track violation data in Entrata. - Upload Environmental Reports to the SharePoint portal. - Assist with mold database. - Enter Worker’s Comp employee data into STARS database for OSHA log reports. Keys to Success - Detail Oriented: You are consistently accurate, have an eye for detail and would always spot an error. - Winner: You are driven and want to be known for your best work and working for a winning team. You are someone who wants to make an impact! - Team member: You are passionate about collaboration and being part of a driven team! You will be engaging in the overall advancement of the Risk Management team’s contribution to a very large US-based property management corporation! - Motivated: You keep yourself focused and on tasks and want to grow in your role. You’ll be responsible for seeking education opportunities and self-improvement for personal growth and development. What We’re Looking For - Experience working in a corporate work environment. - Some professional apartment property insurance experience preferred. - Strong Excel skills. - Self-starter and ability to multi-task. - Ability to research and report results. - Good communications and excellent customer service skills. - Very detail oriented, organized, high quality and proven track record of property management and/or insurance claim process work, following policies & procedures closely, effective communicator with productive work ethic. Technical Requirements - Internet speed minimum 30mbps: Needs to be Wired (Buy a dongle if no LAN port). - i5 11th Gen or higher. - Windows 11 / MacOS Catalina or higher. - Minimum of 8 GB RAM. - Private and quiet dedicated home office area (no roosters, dogs, children's noises in the background). - Back-ups in case of power or internet provider interruptions. - Good headset and webcam (preferably noise-canceling headset). Benefits - Competitive Salary — We offer a competitive salary that reflects the candidate’s experience, skills, and responsibilities. - Remote Work — This role is 100% remote, allowing flexibility and eliminating daily commute. - Paid Time Off — Standard leave entitlements (vacation, sick leave, vacation leave) for rest and well-being. - HMO Coverage — Company-provided HMO plan, offering access to medical services via accredited hospitals and clinics under a Health Maintenance Organization. This helps ensure employees have access to routine checkups, consultations, and coverage for medical care.
