Clinical Insurance Authorization Specialist

US Oncology Inc.; Antioch (CA); On-site; USD 35,000 - 46,000; Full time

Job summary

US Oncology Inc. is seeking an Authorization Specialist to review work queues, determine required services, CPT/HCPC codes, and collect necessary medical records for payer submissions.

The role emphasizes timely follow-up and clear communication between sites and the Authorization Department. The position requires navigating payer guidelines, ensuring accuracy of orders, and attaching required documents to submissions.

Qualifications

• High school degree or equivalent.
• Associates degree in Business Admin/related field preferred.
• Certificate Medical Billing or Insurance preferred.

Responsibilities

• Perform timely review of assigned WQs to ascertain next steps; prioritizing requests based on due date, stat, urgent, etc.
• Review patient chart for MD orders to determine services/CPTs/HCPCs and reasons for requests.
• Review insurance guidelines. If services requested meet medical necessity, gather data for phone, online or fax submissions.
• If services do not meet guidelines, contact RCAUTHSUP or ordering provider for next steps; request peer-to-peer or written appeal if denied.
• Enter authorized services into system and document all notes from calls.
• Provide communication for sites/providers via email, phone and/or in-basket.
• Maintain in-basket and fax folders; import medical guidelines via E-scan into EPIC.
• Assist in managing in-basket messages; ensure timely responses within 48 hrs.
• Assist in managing WQ; ensure goals met, notes updated, and delayed referrals reviewed.

Education

High school degree or equivalent

Associates degree in Business Admin/related field preferred

Certificate Medical Billing or Insurance preferred

Job description

US Oncology Inc. is seeking an Authorization Specialist to review work queues, determine required services, CPT/HCPC codes, and collect necessary medical records for payer submissions.

The role emphasizes timely follow-up and clear communication between sites and the Authorization Department. The position requires navigating payer guidelines, ensuring accuracy of orders, and attaching required documents to submissions.