Oncology Prior Authorization Specialist

CentraState Healthcare System; Freehold (NJ); On-site; USD 34,440 - 55,104; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

PTO (Paid Time Off)

Tuition Reimbursement

403(b) Retirement Plan

Job summary

CentraState Medical Center in Freehold, NJ, seeks a Prior Authorization Specialist to review oncology regimens and inpatient oncology admissions, ensuring timely approvals and reimbursement. Responsibilities include obtaining pre-certifications, authorizations, and medical necessity verifications, while researching denials and coordinating with insurers.

You will work with nurses, physicians, and payors to minimize delays and explore funding options, using EPIC or Mosaiq systems to monitor work

Qualifications

• High School Diploma or Equivalent required.
• Bachelor's Degree preferred.
• Minimum three (3) years medical insurance verification and authorization required.
• Oncology therapy experience required.
• Knowledge of contracts, insurance benefits, exclusions, and billing rules.
• Ability to navigate payor adjudication processes.
• Strong customer service and patient-focused orientation.
• Excellent verbal and written communication skills.
• Ability to multitask, prioritize, and manage time effectively.
• Proficient computer skills (Word, Excel, Outlook).
• Epic or similar EMR experience preferred.
• Knowledge of medical terminology required.

Responsibilities

• Review medical necessity for patient therapies and all required documentation.
• Communicate with nurses and physicians regarding insurance plan restrictions.
• Provide feedback to physicians on pathway documentation and payer issues.
• Update coding/payor guidelines for clinical staff and track denials.
• Obtain insurance authorization and pre-certification for therapy services.
• Act as patient advocate, liaise between patient and payor to answer reimbursement questions.
• Research additional resources to avoid denials for non-covered services.
• Provide patient community resources and financial assistance information.
• Maintain proficiency with EMR/ payor websites and confidentiality rules.
• Stay informed on therapy authorization requirements and regulatory guidelines.
• Process authorization queues daily and perform other duties as needed.

Education

Bachelor's Degree preferred

Tools

Epic

MS Office

Job description

CentraState Medical Center in Freehold, NJ, seeks a Prior Authorization Specialist to review oncology regimens and inpatient oncology admissions, ensuring timely approvals and reimbursement. Responsibilities include obtaining pre-certifications, authorizations, and medical necessity verifications, while researching denials and coordinating with insurers.

You will work with nurses, physicians, and payors to minimize delays and explore funding options, using EPIC or Mosaiq systems to monitor work