Authorization Specialist

COS Carolina Oncology Specialists, P.A.; Charlotte (NC); Remote; USD 45,000 - 60,000; Full time

Job summary

Carolina Oncology Specialists in North Carolina seeks an Authorization Specialist to obtain and verify prior authorizations for oncology services, ensuring timely approvals and compliance with payer requirements. You will review orders for medical necessity, coordinate with physicians and staff, and maintain accurate records in the EHR/PM system to support efficient patient care and minimize delays.

Strong attention to detail and communication with payers are essential, especially for complex

Qualifications

• 2-3 years of experience in healthcare prior authorizations or revenue cycle.
• Knowledge of Medicare, Medicaid, and commercial payers.
• Certification in medical billing/coding (CPC, CPAR or similar) preferred.
• Familiarity with oncology or specialty-practice authorization processes is preferred.

Responsibilities

• Obtain prior authorizations for oncology services in a timely manner.
• Review orders and treatment plans for medical necessity prior to submission.
• Communicate with payers to secure approvals and document authorization details.
• Track authorization status and follow up to prevent delays in patient care.
• Collaborate with physicians and staff to resolve authorization issues or denials.
• Submit appeals with supporting documentation for denials when appropriate.
• Maintain accurate records in the EHR and/or practice management system.
• Verify insurance benefits and patient eligibility as needed.
• Ensure compliance with payer guidelines and regulatory requirements.
• Identify trends in denials or delays and escalate to leadership for process improvement.

Skills

Healthcare prior authorizations

Medical billing

Communication skills

Attention to detail

Team collaboration

Education

High school diploma or equivalent

Medical billing/coding certification (CPC/CPAR preferred)

Tools

EHR/Practice Management Systems

Job description

Carolina Oncology Specialists has been providing compassionate, patient-centered care since 1983, delivering high-quality oncology and hematology services tailored to each individual's needs. Patients benefit from the convenience of receiving chemotherapy treatments in our clinics, along with expert diagnosis, treatment, and management of a wide range of blood disorders.

Why Join Us? We are seeking talented, compassionate, and highly motivated individuals who are passionate about making a difference. At Carolina Oncology Specialists, you'll have the opportunity to support the meaningful work of community oncology while helping provide exceptional care and hope to the patients and families we serve. Join a team dedicated to clinical excellence, collaboration, and improving lives every day.

Job Title: Authorization Specialist Department: Revenue Cycle Management Location: Carolina Oncology Specialists-Remote
Reports To: Authorization Manager

Position Summary

The Authorization Specialist is responsible for obtaining and verifying prior authorizations for oncology services, including chemotherapy, radiation therapy, imaging, and supportive care. This role ensures timely approvals, minimizes treatment delays, and maintains compliance with payer requirements while supporting high-quality patient care.

Key Responsibilities

• Obtain prior authorizations for oncology treatments, procedures, medications, and diagnostic services in a timely manner
• Review provider orders, treatment plans, and clinical documentation to ensure medical necessity and completeness prior to submission
• Communicate with insurance companies, payers, and specialty pharmacies to secure approvals and document authorization details
• Track authorization status and follow up to prevent delays in patient care
• Collaborate with physicians, nurses, and clinical staff to resolve authorization issues or denials
• Submit appeals and provide supporting documentation for denied services when appropriate
• Maintain accurate and detailed records in the electronic health record (EHR) and/or practice management system
• Verify insurance benefits, coverage limitations, and patient eligibility as needed
• Ensure compliance with payer guidelines, regulatory requirements, and organizational policies
• Identify trends in denials or delays and escalation issues to leadership for process improvement

Qualifications

• High school diploma or equivalent
• Minimum of 2-3 years of experience in healthcare prior authorizations, medical billing, or revenue cycle operations
• Knowledge of insurance plans, including Medicare, Medicaid, and commercial payers
• Experience working with EHR and practice management systems
• Strong attention to detail and organizational skills
• Experience in oncology or specialty practice (Preferred)
• Certification in medical billing/coding (e.g., CPC, CPAR, or similar) (Preferred)
• Familiarity with chemotherapy regimens and oncology-specific authorization processes (Preferred)

Key Competencies

• Strong communication and interpersonal skills
• Ability to manage multiple priorities in a fast-paced environment
• Problem-solving and critical thinking
• High level of accuracy and attention to detail
• Customer service orientation with a patient-centered approach

Working Conditions

• Primarily office-based or remote work environment
• Frequent use of computers, phones, and healthcare systems
• May require extended periods of sitting and screen time

Physical Requirements

• Ability to sit for extended periods
• Ability to use standard office equipment, including computers and telephones

Our team values the work components of every member to create a culture of people helping people and making a difference in our lives and those we serve.