Insurance Authorization Specialist (Oncology)

Location: Round Rock, Texas, United States. The role is described as remote, but regularly scheduled presence at the employee site and in-person interaction are required.

Company

hirify.global supports Texas Oncology in delivering evidence-based community oncology care through a large network of providers and clinics.

What you will do

• Review, process, and audit the medical necessity and documentation for chemotherapy treatments.
• Obtain insurance authorizations and pre-certifications for chemotherapy services.
• Communicate payer restrictions and special requirements to nursing and medical staff.
• Research denied or non-covered chemotherapy services and identify alternative payment resources.
• Act as a patient advocate and liaison between patients and payers regarding reimbursement questions.
• Update coding and payer guidelines, track treatment pathways, and support business office functions.

Requirements

• High school diploma or equivalent.
• At least three years of medical insurance verification and authorization experience preferred for Level 1.
• For the Senior level, at least three years of medical insurance verification and authorization experience plus two years of clinical review experience are required.
• Knowledge of chemotherapy authorization requirements, payer coverage rules, and state and federal regulations.
• Ability to manage changing priorities, apply sound judgment, and maintain quality and confidentiality standards.
• Regular presence at the employee site during scheduled business hours is required.

Nice to have

• Associate degree in Healthcare.
• LPN state license and registration.

Culture & Benefits

• Medical, vision, and dental benefits.
• 401(k) plan and paid holidays.
• Opportunities for professional growth.
• Work in an oncology and hematology clinic environment with in-person collaboration.