Oncology Prior Authorization Specialist (Chemo)

DeKalb Health; Little Rock (AR); On-site; USD 42,000 - 66,000; Full time

Job summary

DeKalb Health in Little Rock, AR seeks a Pre-Certification Specialist II, Chemo to obtain and manage prior authorizations for chemotherapy, immunotherapy, and other oncology services. You will verify insurance coverage, review payer requirements, and coordinate documentation to support timely treatment.

You will collaborate with physicians, clinical staff, and payers to resolve authorization issues, track requests, and assist with denials and appeals while maintaining patient confidentiality.

Qualifications

• Minimum of three years of direct experience obtaining and managing prior authorizations for medical services, medications, procedures, or specialty services.
• Oncology, chemotherapy, immunotherapy, or other specialty drug authorization experience strongly preferred.
• Experience working within payer portals such as UHC, BCBS, commercial insurance, Medicare, Medicaid, and/or other third-party payers.
• Working knowledge of ICD-10-CM, CPT, and HCPCS coding and the ability to use coding information to support authorization and coverage research.

Responsibilities

• Verify and maintain accurate patient demographic, insurance, eligibility, benefit, and authorization information.
• Review chemotherapy and oncology-related orders and supporting documentation to identify payer-specific authorization requirements.
• Obtain, prepare, submit, and manage prior authorizations for chemotherapy, immunotherapy, specialty medications, and other oncology-related services.
• Research and apply payer policies, coverage guidelines, and established authorization criteria to ensure required documentation is submitted.
• Coordinate with physicians, clinical staff, pharmacy, and other departments to obtain required clinical documentation and resolve authorization-related issues.
• Monitor authorization requests, follow up with payers, and document authorization status, determinations, and communications to prevent treatment delays.
• Assist with authorization denials, reconsiderations, and appeals by gathering required information and coordinating appropriate follow-up.
• Manage assigned work queues and reports to ensure authorization requests are processed accurately and within established timeframes.
• Communicate authorization requirements, determinations, delays, and potential barriers to appropriate clinical and operational staff.
• Maintain patient confidentiality, comply with organizational policies and applicable regulations, and perform other duties as assigned.

Skills

Prior authorization

Oncology experience

Payer portals

ICD-10-CM CPT coding

Communication

Education

High school diploma

Healthcare administration coursework

Revenue cycle certification (preferred)

Tools

UHC portal

BCBS portal

Medicare portal

Job description

DeKalb Health in Little Rock, AR seeks a Pre-Certification Specialist II, Chemo to obtain and manage prior authorizations for chemotherapy, immunotherapy, and other oncology services. You will verify insurance coverage, review payer requirements, and coordinate documentation to support timely treatment.

You will collaborate with physicians, clinical staff, and payers to resolve authorization issues, track requests, and assist with denials and appeals while maintaining patient confidentiality.