Prior Authorization Specialist

Astera Cancer Care; Huntsville (AL); On-site; USD 38,000 - 52,000; Full time

Job summary

Clearview Cancer Institute in north Alabama is seeking a Prior Authorization Specialist to ensure timely and accurate health plan approvals for oncology care.

You will track, obtain, and extend authorizations, communicate with physicians and RNs, review treatment plans against authorizations, and maintain efficient billing workflows in a busy clinic.

This role supports patient care by reducing delays and coordinating with carriers, doctors, and the billing team.

Qualifications

• Experience obtaining health plan prior authorizations via online portals, phone or fax.
• Ability to navigate health plan websites for medical policy review.
• Must be organized and efficient in a fast-paced environment.
• Ability to follow directions and/or work independently.
• Oncology experience and familiarity with oncology medications are preferred.

Responsibilities

• Track, obtain, and extend authorizations from carriers in a timely manner.
• Check daily/weekly/monthly schedules for prior authorizations and request necessary authorizations.
• Communicate with physicians and RNs regarding treatment and authorizations.
• Verify prior authorizations align with patient treatment plans and insurance payments.
• Other duties as assigned.

Skills

Health insurance plans knowledge

Prior authorization experience

Portal navigation

Organization

Prioritization

Independent work

Education

High school diploma or equivalent

Certified Pharmacy Technician preferred

Job description

Clearview Cancer Institute is north Alabama's leading cancer treatment facility. For over 30 years Clearview Cancer Institute has provided leading-edge treatment and compassionate care to those diagnosed with cancer or blood disorders. Clearview offers every service and amenity needed in an outpatient setting and our dedication to research and involvement in Phase I-IV clinical trials gives our patients the opportunity to receive potentially life-saving treatment options.

Why Join Us?

We are looking for talented and highly-motivated individuals who demonstrate a natural desire to support the meaningful work of community oncologists and the patients we serve.

Job Description:

Job Purpose

The purpose of the Prior Authorization Specialist is to ensure all necessary prior authorizations have been obtained in an effective and efficient manner.

Essential Job Functions

• Responsible for tracking, obtaining, and extending authorizations from various carriers in a timely manner.
• Check daily, weekly, and monthly schedules for prior authorizations and request necessary authorizations.
• Communicate with Physicians and RN’s regarding treatment.
• Check previous patient treatment with current treatment to ensure insurance payments and prior authorizations have been entered/approved.
• Other duties as assigned.

Qualifications

• Must have knowledge of Health Insurance Plans
• Experience in obtaining Health Plan Prior Authorization thru online portals and/or by phone or fax
• Ability to navigate Health Plan websites for medical policy review regarding services
• Must be organized and efficient
• Must be able to prioritize and complete tasks in a timely manner
• Must be able to follow directions and/or work independently

Education/Experience

• Must have a high school diploma or equivalent
• Certified Pharmacy Technician preferred, but not required
• Oncology experience required
• Familiarity with oncology medications preferred
• Prior Authorization experience preferred

Working conditions

This position works in the billing department of a busy oncology/hematology clinic. This person generally only has contact with patients via phone.

Physical requirements

This position requires that the employee be able to sit at a desk in front of a computer for up to eight hours a day. Some walking and standing may be required to complete tasks.

Direct Reports

This position is not a supervisory position. We are looking for compassionate, adaptable individuals who demonstrate the desire to lead and work together to best treat the patients we serve.