Chemo Pre-Certification & Authorization Specialist

CARTI; Little Rock (AR); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Job summary

CARTI is seeking a Pre-Certification Specialist II, Chemo to obtain and manage prior authorizations for chemotherapy and related oncology services. The role verifies insurance coverage, reviews payer requirements, and coordinates necessary documentation to support timely treatment.

The position collaborates with clinical and operational teams to resolve authorization issues, minimize delays, and ensure accurate processing within established timeframes.

Qualifications

• Three years of direct experience obtaining and managing prior authorizations required.
• Oncology/chemotherapy authorization experience strongly preferred.
• Experience with payer portals (UHC, BCBS, Medicare/Medicaid) is beneficial.

Responsibilities

• Verify patient demographics, insurance, eligibility, benefits, and authorization data.
• Review orders to identify payer authorization requirements for oncology services.
• Obtain, prepare, submit, and manage prior authorizations for chemo and related services.
• Research payer policies and documentation requirements for approvals.
• Coordinate with physicians and departments to gather necessary clinical information.
• Monitor requests and follow up with payers to prevent delays.
• Assist with denials, appeals, and tracking of outcomes.
• Manage work queues and ensure timely processing of authorizations.
• Communicate authorization status and barriers to care teams.
• Maintain patient confidentiality and comply with regulations.

Skills

Prior authorizations

Oncology authorization

Payer portals

Insurance eligibility

Medical billing knowledge

Documentation management

Education

High school diploma or GED

Healthcare administration coursework

Medical billing knowledge (preferred)

Tools

ICD-10-CM

CPT

HCPCS

Job description

CARTI is seeking a Pre-Certification Specialist II, Chemo to obtain and manage prior authorizations for chemotherapy and related oncology services. The role verifies insurance coverage, reviews payer requirements, and coordinates necessary documentation to support timely treatment.

The position collaborates with clinical and operational teams to resolve authorization issues, minimize delays, and ensure accurate processing within established timeframes.