Insurance Authorization Specialist

Insurance Authorization Specialist

Join to apply for the Insurance Authorization Specialist role at Maryland Oncology Hematology . This full-time hybrid position supports Proton Radiation and Chemo Regimens at our clinic.

Overview

The US Oncology Network is looking for an Insurance Authorization Specialist to join our team at Texas Oncology . This position will support the Proton Radiation and Chemo Regimens at our 1501 W. Royal Lane clinic in Irving, Texas. Typical work week is Monday through Friday, 8 : 00 a.m. - 4 : 30 p.m. This position will be either a Level 1 or Sr based on candidate work experience.

Responsibilities

• Review, process, and audit medical necessity documentation for proton beam radiation therapy and select chemotherapy regimens.
• Coordinate peer-to-peer reviews and prepare appeal letters for denied insurance cases.
• Obtain insurance authorizations and pre-certifications specifically for proton radiation treatments and select chemotherapy regimens.
• Serve as a patient advocate and liaison between patients and insurance payers to address reimbursement inquiries and prevent treatment delays.
• Educate patients on the authorization process, including peer-to-peer reviews and appeals.
• Maintain current knowledge of authorization requirements across all payers, as well as state and federal regulations related to coverage and authorization.
• Ensure strict compliance with confidentiality standards, including HIPAA and other state and federal patient privacy regulations.
• Perform additional duties as assigned.

Qualifications

Level 1

Level Sr

Competencies

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. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients and 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.

Seniority Level

Mid-Senior level

Employment type

Full-time

Job function

Other

Industries

Hospitals and Health Care

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