Insurance Authorization Specialist

The US Oncology Network is seeking an Insurance Authorization Specialist to support the Oncology Department at Texas Oncology's 4101 James Casey Street #100 clinic in Austin, Texas. This full-time remote position is part of a mission-driven team delivering high-quality, evidence-based cancer care to communities across Texas.

About the Role

As an Insurance Authorization Specialist, you will ensure timely reimbursement for chemotherapy treatments by obtaining pre-certifications, reviewing regimens, and resolving denials. You will act as a liaison between patients, payers, and clinical staff to prevent treatment delays and advocate for patient access to care.

Responsibilities

• Reviews, processes, and audits medical necessity for chemotherapy treatments and pathway adherence documentation.
• Communicates insurance restrictions or special requirements to nursing and medical staff.
• Provides feedback to physicians and management on pathway documentation issues and payer non-coverage issues.
• Updates coding and payer guidelines for clinical staff.
• Obtains insurance authorization and pre-certification for chemotherapy services.
• Acts as a patient advocate and liaison between patients and payers to resolve reimbursement questions and avoid delays.
• Researches alternative resources for non-covered chemotherapy services to prevent payment denials.
• Provides patients with a contact list for community resources, including special programs, drugs, and financial assistance.
• Maintains up-to-date knowledge of chemotherapy authorization requirements for all payers and regulatory guidelines.
• Adheres to confidentiality, state, federal, and HIPAA laws regarding patient records.
• Performs other duties as assigned.

Requirements

• Level 1:
  • High school diploma or equivalent; Associate’s degree in Healthcare or LPN license preferred.
  • Minimum of three years of medical insurance verification and authorization experience preferred.
• Senior Level (in addition to Level 1 requirements):
  • Minimum of three years of medical insurance verification and authorization experience.
  • Two years of clinical review experience required.

Skills

• Up-to-date knowledge of insurance authorization processes and industry standards.
• Ability to handle shifting priorities, ambiguity, and rapid change with resilience.
• Sound judgment in decision-making under uncertainty.
• Commitment to high-quality work and continuous improvement.
• Strong communication and advocacy skills for patient and payer interactions.

Benefits

• Medical, dental, and vision coverage.
• 401K retirement plan.
• Paid holidays.

Schedule

Monday through Friday, 8:00 AM – 5:00 PM.

Physical Demands

• Regularly required to sit or stand, talk, or hear during scheduled business hours.
• Full range of body motion, including handling and lifting patients, manual dexterity, and eye-hand coordination.
• Extensive periods of standing and walking.
• Occasional lifting and carrying of items up to 40 lbs.
• Requires corrected vision and hearing within normal range.

Work Environment

• Potential exposure to communicable diseases, toxic substances, ionizing radiation, and medical preparations common in an oncology/hematology clinic.
• In-person interaction with co-workers, management, and clients.
• Minimal travel by automobile to office sites may be required.