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Prior Authorization
4 weeks ago
Job Summary:
We are seeking a detail-oriented and proactive Prior Authorization Specialist with a focus on Oncology to join our growing team. The ideal candidate will have 1–3 years of experience in the US healthcare system and be familiar with the authorization requirements of major oncology treatments and payers. This role involves coordinating prior authorizations for oncology-related services, working closely with physicians, insurance providers, and cancer centers to ensure timely patient care.
Key Responsibilities:
- Review and process prior authorization requests for oncology medications, diagnostics, and treatments.
- Communicate with insurance companies to obtain approval for oncology services.
- Collaborate with oncologists, medical assistants, and billing teams to ensure accurate and complete submissions.
- Verify insurance benefits and document all authorization details in EMR and other systems.
- Monitor and follow up on pending authorizations and escalate issues as needed.
- Stay updated on payer guidelines, formularies, and coverage policies related to oncology.
- Maintain confidentiality and compliance with HIPAA regulations at all times.
Required Qualifications:
- 1 to 3 years of prior authorization experience in US healthcare, preferably in oncology.
- Working knowledge of insurance plans, including Medicare, Medicaid, and commercial payers.
- Familiarity with oncology treatment plans, drug names, and diagnosis codes (ICD/CPT).
- Strong communication and documentation skills.
- Proficiency in healthcare systems and tools such as Google Sheets, Google Docs, EMRs, and payer portals.
