• Oncology Authorization Specialist

    Scotland Health Care System (Laurinburg, NC)


    Position Summary: The Oncology Authorization Specialist plays a vital role in ensuring patients receive timely access to chemotherapy (IV and oral), hydration, infusion-based therapies, and radiation treatments. This position safeguards both patient care and Scotland Healthcare System’s reimbursement processes by managing prior authorization requests with precision and efficiency.

     

    Duties and Responsibilities

     

    + Coordinate with insurance payers, clinical staff, and patients to process prior authorization requests for oncology, infusion, and radiation therapies.

    + Communicate with physicians, patients, and payers to secure and/or provide missing demographic, insurance, and/or clinical information to authorize service(s).

    + Communicates with management to identify payer trends and resolve potential issues.

    + Documents all communications thoroughly, including payer decisions, in a timely manner.

    + Maintain meticulous records of authorization requests, approvals, and denials to support audits and reimbursement processes.

    + Serve as the liaison between the oncology clinical care team and insurance payers, ensuring clear communication of insurance guidelines and requirements.

    + Identify patients who may need financial assistance and/or drug assistance programs and communicate with the care team and navigators to connect patients with available resources.

    + Delivering outstanding customer service to patients and staff, ensuring empathy and professionalism in every interaction.

    + Provide backup coverage for outpatient prior authorization functions and other assignments as directed by the Director of Patient Financial Services (PFS).

    + Maintains a level of productivity suitable for the department.

    Position Qualifications

    Education:

    + Associate's degree in healthcare administration, Business or related field is preferred.

    Experience:

    + 1–3 years of experience in an office or hospital healthcare setting is required.

    + Experience in oncology, infusion therapy, or radiation therapy authorizations.

    + Experience in revenue cycle

    + Familiarity with ICD-10 and CPT coding required.

    + Strong working knowledge of medical terminology

     

    Knowledge, Skills, Abilities

     

    + Familiarity with payer Medical Policies, NCD, LCD.

    + Familiarity with Epic EHR.

    + Strong time management and prioritization skills.

    + Excellent communication and customer service with patients and staff.

    + Strong attention to detail.