The US Oncology Network · 18 hours ago
Insurance Clinical Reviewer
Fort Worth, TX
Full-time
Hybrid
Entry, Mid, Senior Level
3+ years expThe US Oncology Network is looking for a Clinical Insurance Reviewer to join Texas Oncology, the largest community oncology provider in the country. This role involves reviewing chemotherapy regimens for compliance with reimbursement guidelines, obtaining necessary pre-certifications, and acting as a liaison between patients and payers to ensure timely reimbursement for treatments.
CommunitiesHealth CareMedicalOncologyTest and Measurement
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 particular 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. Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patient’s records
Other duties as requested or assigned
Qualification
Required
High school degree or equivalent
Minimum three (3) years medical insurance verification and authorization required for Level Sr
Minimum three (3) years medical insurance verification and authorization preferred for Level 1
Minimum two (2) years clinical review experience required for Level Sr
Preferred
Associates degree in Healthcare, LPN state license and registration preferred
Minimum three (3) years medical insurance verification and authorization preferred
Company
The US Oncology Network
Every day, The US Oncology Network helps approximately 3,300 providers deliver value-based, integrated care for patients—close to home.
10001+ employees
H1B Sponsorship
The US Oncology Network has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2023 (1)
Funding
Current Stage
Late StageTotal Funding
unknown2010-12-30Acquired
Leadership Team
R. Steve Paulson
National Policy Board Executive Committee
Recent News
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