Lead Eligibility Specialist

The US Oncology Network is looking for an Eligibility Specialist Lead to join our team at Texas Oncology! This full time hybrid remote position will support our Central Business Office location. This position does require that the candidate lives within the state of Texas.

Join our team: Are you looking for a workplace that truly values and supports you? Our department is dedicated to creating a positive environment where your career can flourish. We're all about your growth, offering personalized assistance to help you seize every opportunity for career advancement. We believe in meaningful communication through our monthly 1:1 sessions, ensuring your goals and needs are front and center. Stay informed and connected with our monthly team meetings, where we share the latest company news and department updates. Life happens, and that's why we offer flexible shifts to help you achieve a healthy balance between work and personal commitments. If you're ready to thrive in a workplace that puts you first, we'd love to hear from you!

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 founders pioneered community-based cancer care because they believed in making the best available cancer care accessible to all communities, allowing people to fight cancer at home with the critical support of family and friends nearby. Our mission is still the same today-at Texas Oncology, we use leading-edge technology and research to deliver high-quality, evidence-based cancer care to help our patients achieve "More breakthroughs. More victories." in their fight against cancer. Today, Texas Oncology treats half of all Texans diagnosed with cancer on an annual basis.

The US Oncology Network is one of the nation's largest networks of community-based oncology physicians dedicated to advancing cancer care in America. The US Oncology Network is supported by McKesson Corporation focused on empowering a vibrant and sustainable community patient care delivery system to advance the science, technology, and quality of care.

What does the Eligibility Specialist Lead do?

With little to no supervision, coordinates the daily operations of the team. The team is responsible for the successful resubmission of invoices to the responsible party. Analyzes and resolves eligibility variances via web research and/or direct contact with patients. Coordinates the activities for the acquisition of referrals and retro-authorizations, where applicable. Resolves escalated routine and complex inquiries and problems. Relies on extensive experience and judgment to plan and accomplish goals. A certain degree of creativity and latitude is required. Orients, trains, and assigns the work of level I, II & Sr employees. Is the designated lead employee to coordinate the daily operations of the department. Follows standard procedures and pre-established guidelines to complete tasks. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards, and US Oncology's Shared Values.

The essential duties and responsibilities:

• Researches and obtain accurate and current insurance coverage information, makes corresponding corrections in the PMS.
• May evaluate benefits and eligibility to assess patient financial responsibility.
• May coordinates referral from primary care clinic to ensure appropriate authorizations are secured and entered into the PMS.
• Identifies uninsured patients and refers to patient benefit representative for coordination of payment.
• Communicates system issues and/or payor trends lead or supervisor.
• May answer questions and resolve complaints.
• Documents conversations with payors in the PMS.
• Contacts and follows up with clinic or any missing or incomplete documentation.
• Works ETM and TES edits.
• Manages complex payor eligibility and referrals, as well as hospital accounts.
• Makes inbound and outbound calls in relation to retroactive referrals, denials, payor inquiries, patient inquiries.
• Assesses site specific procedures to ensure accurate revenue/charge capture. Summarizes audit findings and preliminary recommendations for management review.
• Researches and responds to routine account inquiries and takes appropriate action; escalates non-routine issues, makes recommendations for solutions to unique situations.
• Proactively identifies processes and procedures and develops tools to improve efficiencies.
• Trains new coworkers on policies and procedures. Double checks co-workers work and provides procedure guidance. May research, resolve, or provide direction on co-workers escalated issues.
• Researches and responds to routine, non-routine, and complex inquiries in a timely and professional manner.
• Responsible for maintaining current job family standard operating procedures (SOP) files as a desk reference.
• Works with network support on enhancement and optimization initiatives.
• Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patient's records and collections.
• Other duties as requested or assigned.

The ideal candidate for the position will have the following background and experience:

• High school diploma or equivalent required. Associates degree preferred.
• Position requires five (5) years with front desk, registrations, healthcare benefits or equivalent experience.
• Proficiency with computer systems and Microsoft Office (Word and Excel) required.

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 will be offered 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 and 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.