Texas Oncology · 8 hours ago
Insurance Clinical Reviewer
Fort Worth, TX
Full-time
Onsite
Entry, Mid, Senior Level
3+ years expTexas Oncology is part of The US Oncology Network, the largest community oncology provider in the country. The Clinical Insurance Reviewer will review chemotherapy regimens according to reimbursement guidelines, obtain necessary pre-certifications, and serve as a liaison between patients and payers to ensure timely reimbursement for treatments.
AssociationBiotechnologyHealth CareOncology
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
Texas Oncology
Founded in 1986, Texas Oncology is a pioneer in high quality community-based cancer care.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Steve Paulson
CEO
Jason Shook
Chief Operating Officer | Chief Financial Officer
Recent News
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