Insurance Reviewer Clinical

Job Full Description

Insurance Reviewer Clinical


Location: Ocala, Florida


This is an exciting opportunity to work in a fast-paced oncology/hematology environment where your expertise directly impacts patient care and treatment access. Are you experienced in medical insurance verification and passionate about helping patients navigate complex healthcare coverage? We are looking for a dedicated Insurance Reviewer Clinical professional to join our growing team supporting our Ocala locations.

Position Overview


Under general supervision, the Insurance Reviewer Clinical is responsible for reviewing chemotherapy regimens for reimbursement compliance, obtaining authorizations and pre-certifications, researching denied services, and ensuring timely reimbursement for treatments. This role serves as a critical liaison between patients, providers, and insurance payers while supporting high-quality patient care.

Qualifications

Minimum Requirements

• Minimum of 3 years of medical insurance verification and authorization experience required
• High school diploma or equivalent required
• Associate degree in Healthcare preferred

Ideal Candidate Will Demonstrate

• Strong technical knowledge of insurance authorization processes
• Excellent communication and problem-solving skills
• Ability to manage changing priorities in a fast-paced environment
• Sound judgment and attention to detail
• Commitment to quality patient support and service excellence

Key Responsibilities

• Review, process, and audit medical necessity for chemotherapy treatments and documentation
• Obtain insurance authorizations and pre-certifications for chemotherapy services
• Communicate insurance restrictions and requirements to nursing and medical staff
• Assist physicians and management with payer and pathway documentation issues
• Research denied claims and identify alternative funding resources
• Advocate for patients to prevent treatment delays due to insurance barriers
• Maintain current knowledge of payer guidelines and regulatory requirements
• Ensure compliance with HIPAA and confidentiality standards
• Support additional business office functions as needed

Work Environment & Physical Requirements


This position is based within an oncology/hematology clinic environment and may involve exposure to medical preparations, communicable diseases, and other healthcare-related conditions. The role requires regular sitting, standing, walking, communication with staff and patients, and occasional lifting of up to 40 lbs.

Referral Bonus Opportunity!


Know someone who would be a great fit? Refer them!


Earn $100-$500 per referral once your referral works 40 hours or more.
The more successful referrals you make, the more you can earn!

How to Apply


Email:


Apply Online: ExpressPros.com/Ocala


Call: View phone number on click.appcast.io


Walk-In: 1005 SW 10th St, Suite 102, Ocala, FL 34471

Why Join Our Team?


We believe in taking care of our employees just as they care for our patients. That's why we offer a comprehensive benefits package including:


? Medical, Dental & Vision Insurance
? Life Insurance
? Short-Term & Long-Term Disability Coverage
? Generous Paid Time Off (PTO)
? 401(k) with Company Match
? Wellness Program Incentives
? Tuition Reimbursement
? Employee Assistance Program
? Employee Discounts at Popular Retailers
? Career Growth Opportunities

Ocala, FL
1281
1005 Southwest 10th Street
Ocala, FL 34471