New

Insurance Authorization Representative

TEKsystems
$24.00 / hr
medical insurance, life insurance, sick time, 401(k), retirement plan
United States, Texas, Harlingen
Apr 02, 2025
TEKsystems is hiring 3 fully remote Insurance Authorization representatives for a large healthcare clinic out of Harligen, TX! * If you have 4+ years of Insurance Authorization experience, as well as obtaining pre-certifications, please email your most updated resume to rsison @ teksystems.com --> these resumes will be reviewed before applications submitted through here. * Job Title: Fully Remote Clinical Insurance Reviewer Start date: 04/14/2025 - must be able to pass standard compliance! Hours: Must be able to work 8a-5p CST Must haves: * Excellent verbal and written communication skills, and computer navigation and typing proficiency * High school diploma or equivalent, Associate's degree preferred and LPB state license and registration preferred * 4 years of medical insurance verification and authorization required Job description: * Under general supervision, review chemotherapy regimens in accordance to reimbursement guidelines, and obtain necessary pre-certifications and exceptions to ensure no delay in reimbursement of treatments. * Research denied services and alternative resources to pay for treatment, actively supporting and adhering to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards. * Review, process, and audit the medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence. * Communicate with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans, providing prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered chemotherapy drugs. * Update coding/payer guidelines for clinical staff and track pathways and perform various other business office functions on an as needed basis. * Obtain insurance authorization and pre-certification specifically for chemotherapy services, working as a Patient Advocate and function as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays. * Research additional or alternative resources for non-covered chemotherapy services to prevent payment denials, providing a contact list for patients' community resources including special programs, drugs, and pharmaceutical supplies and financial resources. * Maintain a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization, adhering to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patients' records. Interview process: one virtual interview with me, and one Microsoft Teams interview with Hiring Managers this Thursday + Friday after 12pm CST. Training information: virtual training for 2 months to learn systems + SOPs. Pay and Benefits The pay range for this position is $24.00 - $24.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: * Medical, dental & vision * Critical Illness, Accident, and Hospital * 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available * Life Insurance (Voluntary Life & AD&D for the employee and dependents) * Short and long-term disability * Health Spending Account (HSA) * Transportation benefits * Employee Assistance Program * Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Apr 15, 2025. About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.