Oncology Authorization & Accreditation Specialist

Carle-Health; Urbana (IL); On-site; USD 28,000 - 45,000; Full time

Job summary

Carle Health is seeking a Cancer Services Specialist in Urbana, IL to manage pre-authorizations, insurance inquiries, and appeals. You will coordinate cancer conferences and ensure accreditation standards are met across facilities in Urbana and Normal.

The role requires experience in healthcare settings and strong communication with payers and staff. This position supports accreditation reporting and data tracking for the cancer program.

Qualifications

• Experience in healthcare settings is preferred.
• Knowledge of pre-auths and insurance denials is beneficial.

Responsibilities

• Assumes primary responsibility with third party payer for screening and authorizations.
• Obtains and follows up on insurance authorizations and eligibility for scheduled exams.
• Checks eligibility against carrier databases.
• Notifies staff of authorization updates and changes.
• Interacts with external customers to educate regarding authorization procedures.
• Resolves denied cases, appeals with carriers, and coordinates with Billing.
• Generates denial letters and assembles appeal documentation.
• Provides recommendations to prevent denials through policy and procedure changes.
• Reviews diagnostic coding for orders and pre-authorizations.
• Schedules and coordinates Administrative Cancer Committee meetings and conferences.
• Assists with reports for accreditation activities.
• Maintains cancer conference case lists and distributes to attendees.

Skills

Healthcare Experience

Insurance Knowledge

Job description

Carle Health is seeking a Cancer Services Specialist in Urbana, IL to manage pre-authorizations, insurance inquiries, and appeals. You will coordinate cancer conferences and ensure accreditation standards are met across facilities in Urbana and Normal.

The role requires experience in healthcare settings and strong communication with payers and staff. This position supports accreditation reporting and data tracking for the cancer program.