Oncology Authorization Specialist II

Saint Francis Hospital, Inc.; Oklahoma; Hybrid; USD 42,000 - 54,000; Full time

Job summary

The Authorization Specialist II at Saint Francis Hospital, Inc. ensures accuracy of insurance information and secures prior authorizations for non-oncology, oncology, and radiation oncology infusions. The role handles NCCN guidelines and medical necessity reviews, coordinating with physicians and pharmacy staff.

You will maintain patient confidentiality, manage complex queues, and support timely billing while delivering excellent service within our Oklahoma health system.

Qualifications

• Basic healthcare knowledge and insurance terminology including medical billing and insurance follow-up processes.
• PC and basic software skills.
• Proven keyboard skills with the ability to type 75 WPM.
• Excellent oral and verbal communication skills.
• Ability to navigate insurance websites to access patient eligibility and payment information.
• Ability to organize and prioritize work and the ability to be detail oriented.
• Ability to interact with physicians, physician offices and all levels of team members within the health system.

Responsibilities

• Monitors patient referrals and denials queues to determine encounters requiring pre-registration, verification, authorization, or corrections.
• Reviews physician orders for medical necessity and notes treatment frequency/duration for revisions as needed.
• Reviews CPT and diagnosis codes to support authorization according to payer guidelines.
• Processes authorizations and validates requests are within timelines and compliant with insurance guidelines.
• Coordinates with pharmacy and clinical staff to identify codes for authorization submission and NCCN alignment.
• Communicates with patients, physician offices, and financial counselors to obtain additional information.
• Documents information in the system per department standards and protects patient privacy.

Skills

Benefits verification

Authorization experience

Medical terminology

Typing 75 WPM

Communication skills

Insurance portals

Education

High School Diploma or GED

Tools

EHR systems

Basic PC software

Job description

The Authorization Specialist II at Saint Francis Hospital, Inc. ensures accuracy of insurance information and secures prior authorizations for non-oncology, oncology, and radiation oncology infusions. The role handles NCCN guidelines and medical necessity reviews, coordinating with physicians and pharmacy staff.

You will maintain patient confidentiality, manage complex queues, and support timely billing while delivering excellent service within our Oklahoma health system.