Authorization Specialist: Medical Billing & Verification

OneOncology, LLC; United States; On-site; USD 42,000 - 64,000; Full time

Job summary

OneOncology, LLC is seeking an Authorization Specialist to manage outpatient diagnostic testing authorization and pre-certifications. You will verify insurance requirements, obtain pre-authorizations, and coordinate with physicians, patients, and billing staff to ensure timely approvals.

Candidates should have a high school diploma and at least one year of prior authorization experience; familiarity with payer guidelines and EMR systems is important.

Qualifications

• High School diploma or equivalent required.
• 1+ year of Prior Authorization experience preferred.
• Experience with medical insurance terminology and payer guidelines a plus.
• Proficiency in MS Office and EMR systems preferred.

Responsibilities

• Obtains pre-authorizations for diagnostic tests and procedures as required by insurance carriers.
• Verifies patient insurance requirements and reimbursement feasibility.
• Communicates with physicians, nurses, and billing staff to resolve authorization issues.
• Maintains up-to-date documentation in EMR/EBS for approvals and denials.
• Coordinates with hospital/diagnostic facilities for referrals and authorizations.
• Tracks and resolves denials and resubmissions; supports review and appeals as needed.
• Keeps current on payer requirements and policy changes.

Skills

Prior Authorization experience

Customer service

End-user computer applications

Communication

Education

High School diploma or equivalent

Tools

MS Word

Excel

Outlook

Job description

OneOncology, LLC is seeking an Authorization Specialist to manage outpatient diagnostic testing authorization and pre-certifications. You will verify insurance requirements, obtain pre-authorizations, and coordinate with physicians, patients, and billing staff to ensure timely approvals.

Candidates should have a high school diploma and at least one year of prior authorization experience; familiarity with payer guidelines and EMR systems is important.