"Alerted.org

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.