Prior Authorization Specialist: Oncology & Infusion

Medix; Knoxville (TN); On-site; USD 29,000 - 34,000; Full time

Benefits offered by this job

Equipment provided on-site

Job summary

Medix in Knoxville, TN seeks an experienced Prior Authorization Specialist to join our Centralized Business Office (CBO) team on-site. You will secure timely prior authorizations for complex specialty medications, chemotherapy, and infusion regimens, ensuring patients receive needed treatments without delay.

The ideal candidate has hands-on experience with payor portals, supportive documentation for medical necessity, and the ability to navigate barriers like peer-to-peer requirements.

Qualifications

• 2+ years of direct healthcare insurance verification and prior authorization experience.

Responsibilities

• Initiate, track, and secure timely prior authorizations for complex specialty medications, chemotherapy, and infusion regimens.
• Submit clinical documentation to payors to justify medical necessity.
• Navigate major payor portals (BlueCross, Medicare/Medicare Advantage, Humana) using Availity and CoverMyMeds.
• Manage appeals and peer-to-peer workflows to navigate payor white-bagging mandates and protect buy-and-bill operations.
• Serve as primary liaison between the CBO, attending physicians, and clinic staff regarding payor restrictions and authorization status updates.

Skills

Prior authorization experience

Healthcare insurance verification

Payor portal navigation

Attention to detail

Communication skills

Education

Certified Medical Assistant (CMA)

Licensed Practical Nurse (LPN)

Healthcare Financial Counselor

Tools

Availity

CoverMyMeds

Job description

Medix in Knoxville, TN seeks an experienced Prior Authorization Specialist to join our Centralized Business Office (CBO) team on-site. You will secure timely prior authorizations for complex specialty medications, chemotherapy, and infusion regimens, ensuring patients receive needed treatments without delay.

The ideal candidate has hands-on experience with payor portals, supportive documentation for medical necessity, and the ability to navigate barriers like peer-to-peer requirements.