Texas Oncology is searching for a Insurance Clinical Reviewer. The Insurance Clinical Reviewer processes and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence, obtains insurance authorization and pre-certification specifically for chemotherapy services and researches additional or alternative resources for non-covered chemotherapy services to prevent payment denials. Texas Oncology delivers high-quality, high-touch care to help cancer patients achieve "More breakthroughs. More victories."® in their fight against cancer. We are an independent, physician-led practice delivering leading-edge technology and treatment options and conducting innovative research. Founders of the practice pioneered community-based care to enable more cancer patients to receive high-quality care while staying close to the critical support of family and friends. Texas Oncology has more than 150 sites of service throughout Texas, with more than 350 physicians dedicated to serving our patients. On average, we treat more than 50,000 new cancer patients each year, with documented growth year over year. Texas Oncology pioneered the concept of community-based, outpatient, multidisciplinary cancer centers. We give local communities access to leading-edge technology that was previously only available in larger metropolitan areas. Texas Breast Specialists and Texas Urology Specialists are a part of Texas Oncology. Texas Oncology is an affiliate of The U.S. Oncology Network, which is owned by McKesson Specialty Health, a division of McKesson Corporation.
Job Details: 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.
High school degree or equivalent. Associates degree in Healthcare, LPN state license and registration preferred. Minimum three (3) years medical insurance verification and authorization and two (2) years clinical review experience required.
The vision of Texas Oncology is to be the premier provider of oncology and hematology care in the Southwest. We have high standards for patient satisfaction and offer exceptional value in cancer care. We also strive to advance clinical research and develop innovative approaches to treatment of oncology and hematology disorders.
The mission of Texas Oncology is to provide "More breakthroughs. More victories." To this end, we give patients access to the highest quality cancer care available today within their own local communities. Our cutting-edge technologies, treatments and research are offered in welcoming and comfortable environments. We maintain comprehensive quality oversight and responsible financial management. At all times, we pride ourselves in being moral, ethical and efficient as a medical practice and employer.
We extend an extremely competitive offering of benefits to employees, including Medical Health Care, Dental Care, Vision Plan, 401-k with a matching component, Life Insurance, Short-term and Long-term disability and Wellness & Perks Programs.
Come join our growing organization and enjoy knowing that you work for an organization dedicated to making the lives of others better.
The US Oncology Network is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. The US Oncology Network is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
Internal Number: MCKEA00878106
About New York Oncology Hematology
New York Oncology Hematology (NYOH) is the leading provider of community-based cancer care and blood disorder services. With seven convenient locations in Albany, Amsterdam, Clifton Park in Saratoga County, Hudson, Rexford and Troy, our team of 32 physicians and 350 cancer care specialists see more than 100,000 cancer visits a year.
NYOH has always been at the forefront of cancer care. More than 30 years ago, we began as the region’s first oncology practice in a community setting (outside a hospital). A few years later, we offered the first radiation treatment outside a hospital setting.
Today, we continue our commitment of providing world class care, close to home. We offer the region’s largest clinical research and drug trial operation, only stem cell transplant program and only neuro-oncology care. We recently brought the first Varian Truebeam Radiotherapy System to our new practice: Clifton Park in Saratoga County.
Our medical staff includes 32 board certified physicians who specialize in the care of patients with cancer (medical oncology and radiation oncology) and blood-related disorders (hematology). With a patient care team of more than 350 oncology certified nurse...s, pharmacists, laboratory technologists, radiation therapists and support personnel, we are able to provide the personal level of care our patients need during treatment.