Advanced Authorization Specialist
Core
Obtaining highly complex authorizations for in-patient and out-patient services, specifically oncology treatments, surgeries, and specialized therapies.
Role type
Senior IC medical authorization specialist (oncology)
Builds
Approved treatment plans and authorizations for high-cost oncology services
Domain
Healthcare administration / Oncology
Required skills
Medical necessity determination, CPT/HCPCS coding, medical terminology, insurance coordination, denial management, clinical record interpretation
Preferred skills
Epic system experience, database management, billing systems knowledge
Responsibilities
Assess time-sensitive referral queues for complex authorizations; manage high-volume stat requests for life-altering treatments; interpret medical records to prove medical necessity; manage drug formulary changes with payors; review and address monthly denials for chemotherapy and surgeries.
Seniority
Mid-level, hands-on IC