Texas Oncology is looking for an Insurance Reviewer – Clinical to join our team! This position is for the Texas Oncology – Garland location, one of the 175+ sites we have across the state of Texas and southeastern Oklahoma. 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, high-touch, evidence-based cancer care to help our patients achieve “More breakthroughs. More victories.“ ® in their fight against cancer.
Why work for us?
One reason to join our team is because we offer our employees a competitive benefits package that includes Medical, Dental, Vision, Life Insurance, Short-term and Long-term disability coverage, a 401-k plan that comes with a company match, a Wellness program that rewards you just for tracking your steps, and lots of other great perks such as Tuition Reimbursement, an Employee Assistance program and discounts on some of your favorite retailers.
The ideal candidate for the Insurance Reviewer-Clinical 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 of medical insurance verification and authorization required.
What does the Insurance Reviewer-Clinical do?
This Insurance Reviewer-Clinical will review 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.
The essential duties and 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 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.
Texas Oncology is part of the US Oncology Network and 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.
The US Oncology Network is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.