Insurance Authorization Specialist Sr (Oncology)

Location: The Woodlands, Texas, United States; full-time work with regular presence at the employee site during business hours. The role is described as remote but also requires in-person interaction and may require minimal travel to office sites.

Company

hirify.global supports community-based oncology providers, while Texas Oncology delivers evidence-based cancer care across Texas with support from McKesson.

What you will do

• Review, process, and audit medical necessity for chemotherapy treatments and pathway adherence documentation.
• Obtain insurance authorizations and pre-certifications for chemotherapy services.
• Communicate payer restrictions and documentation requirements to nursing, medical staff, physicians, and management.
• Research denied or non-covered chemotherapy services and identify alternative payment, community, pharmaceutical, and financial resources.
• Act as a patient advocate and liaison between patients and payers to resolve reimbursement questions and prevent treatment delays.
• Maintain coding, payer, regulatory, confidentiality, and compliance knowledge and update clinical staff on relevant guidelines.

Requirements

• At least three years of medical insurance verification and authorization experience.
• For the Senior level, at least two years of clinical review experience in addition to the Level 1 requirements.
• High school diploma or equivalent.
• Associate degree in healthcare or an LPN state license and registration is preferred.
• Working knowledge of chemotherapy authorization requirements, payer rules, and state and federal coverage regulations.
• Ability to work Monday through Friday, 8:30 a.m. to 5:00 p.m., with regular presence at the employee site.

Culture & Benefits

• Work within a community oncology and hematology clinic environment.
• Collaborate in person with coworkers, management, clinical staff, patients, and payers.
• Follow the US Oncology Compliance Program, Code of Ethics, Business Standards, and patient confidentiality requirements.
• The work environment may involve communicable diseases, toxic substances, ionizing radiation, medical preparations, and other clinic-related conditions.
• Physical work may include extended standing and walking, handling and lifting patients, and occasionally carrying items weighing up to 40 pounds.