Texas Licensed Insurance Reviewer

Job Summary

To support the West Region locations, the remote Outside Scheduler/Insurance Reviewer Sr will manage outside scheduling of physician referrals, review chemotherapy regimens for reimbursement compliance, and obtain necessary pre-certifications while working Monday through Friday, from 8 AM to 5 PM.

Key responsibilities

• Reviews and processes medical necessity for chemotherapy treatments and communicates with medical staff regarding insurance plan requirements
• Obtains insurance authorization and pre-certification for chemotherapy services, acting as a liaison between patients and payers
• Researches alternative resources for non-covered chemotherapy services to prevent payment denials and maintains knowledge of authorization requirements

Required qualifications

• High school diploma or equivalent; Associate's degree in Healthcare or LPN state license preferred
• Minimum three years of medical insurance verification and authorization experience
• At least two years of clinical review experience