Outside Scheduler/Insurance Reviewer Sr–Remote

Overview

Texas Oncology is seeking an Outside Scheduler/Insurance Reviewer Sr for a REMOTE position supporting West Region locations (Odessa, Midland, Wichita Falls, Amarillo, Abilene, and El Paso). Hours are Monday through Friday, 8:00 AM - 5:00 PM.

Responsibilities

• Reviews medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence.
• Communicates with nursing and medical staff regarding restrictions or special requirements related to insurance plans.
• Provides feedback to physicians and management on pathway documentation issues and payer issues with non-covered chemotherapy drugs.
• Updates coding/payer guidelines for clinical staff.
• Tracks pathways and performs various business office functions as needed.
• Obtains insurance authorization and pre-certification specifically for chemotherapy services.
• Works as a patient advocate and serves as a liaison between the patient and payer to address reimbursement questions and prevent payment denials.
• Researches additional or alternative resources for non-covered chemotherapy services to prevent payment denials.
• Provides a contact list for patients, including community resources, special programs, drugs, 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 HIPAA laws and guidelines with regards to patient records.

Qualifications

• High school degree or equivalent.
• Associates degree in Healthcare, LPN state license and registration preferred.
• Minimum three (3) years medical insurance verification and authorization experience.
• Minimum two (2) years clinical review experience.

Competencies

• Possesses up to date knowledge of the profession and industry.
• Quick learner in the technical/functional area.
• Accesses and uses other expert resources when appropriate.
• Handles day to day work challenges confidently.
• 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.
• Makes timely, cost-effective, and sound decisions.
• Pursues aggressive goals and works efficiently to achieve them.
• 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 and improves efficiencies.