[Hiring] Imaging Authorizations Clinical Reviewer @The US Oncology Network

Role Description

The US Oncology Network is looking for a Clinical Insurance Reviewer to join our team at Texas Oncology. This full-time remote position will support the Diagnostic Imaging Department at our 500 South Henderson Suite 400 clinic in Fort Worth, Texas. Typical work week is Monday through Friday, 8:00a - 5:00p. Must currently reside in Texas.

Note from Hiring Manager: This role handles obtaining authorizations for diagnostic imaging across the state of Texas. We are a centralized team of dedicated reviewers who work well together, are in a relaxed environment, and work to ensure each person has the tools and resources necessary to be successful. This position will be either a level 1 or Sr based on candidate work experience.

As a part of The US Oncology Network, Texas Oncology delivers high-quality, evidence-based care to patients close to home. Texas Oncology is the largest community oncology provider in the country and has approximately 530 providers in 280+ sites across Texas. Our mission is to deliver high-quality, evidence-based cancer care to help our patients achieve “More breakthroughs. More victories.”® in their fight against cancer.

What does the Clinical Insurance Reviewer do? (including but not limited to)

• Under general supervision, reviews in accordance to reimbursement guidelines.
• Obtains necessary pre-certifications and exceptions to ensure no delay in reimbursement.
• Researches denied services.
• Supports and adheres to the US Oncology Compliance Program, including the Code of Ethics and Business Standards.

Responsibilities

• Reviews, processes and audits the medical necessity for each patient.
• 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 documentation issues and payer issues.
• Updates coding/payer guidelines for clinical staff.
• Obtains insurance authorization and pre-certification for services.
• Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
• Maintains a good working knowledge of 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.
• Other duties as requested or assigned.

Qualifications

• Level 1:
• High school degree or equivalent.
• Associates degree in Healthcare, LPN state license and registration preferred.
• Minimum three (3) years medical insurance verification and authorization preferred.
• Level Sr (in addition to level 1 requirements):
• Minimum three (3) years medical insurance verification and authorization and two (2) years clinical review experience required.

Competencies

• Uses Technical and Functional Experience: Possesses up to date knowledge of the profession and industry; regarded as an expert in the technical/functional area; accesses and uses other expert resources when appropriate.
• Demonstrates Adaptability: Handles day to day work challenges confidently; adjusts to multiple demands, shifting priorities, ambiguity and rapid change; shows resilience in the face of constraints, frustrations, or adversity; demonstrates flexibility.
• Uses Sound Judgment: Makes timely, cost effective and sound decisions; makes decisions under conditions of uncertainty.
• Shows Work Commitment: Sets high standards of performance; pursues aggressive goals and works efficiently to achieve them.
• Commits to Quality: 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; improves efficiencies.

Physical Demands

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours.
• Regularly required to sit or stand and talk or hear.
• Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination.
• Requires standing and walking for extensive periods of time.
• Occasionally lifts and carries items weighing up to 40 lbs.
• Requires corrected vision and hearing to normal range.

Work Environment

• The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment.
• Work will involve in-person interaction with co-workers and management and/or clients.
• Work may require minimal travel by automobile to office sites.