Remote Authorization Specialist – Healthcare Claims & Pre-Auth

OneOncology, LLC; United States; Remote; USD 40,000 - 52,000; Full time

Job summary

OneOncology is seeking an Authorization Specialist to manage administrative tasks for outpatient diagnostic testing and procedure benefit verification. The role ensures insurance requirements are met before testing or procedures and secures pre-authorizations as needed.

Responsibilities include communicating with physicians, staff, and insurance coordinators, maintaining EMR documentation, and staying informed on payer guidelines.

Qualifications

• High School diploma or equivalent required.
• 1+ year of Prior Authorization experience preferred.
• Medical insurance background required.

Responsibilities

• Obtains pre-authorizations for physician orders as required by insurance carriers.
• Communicates with physicians and clinical staff on reimbursement and pre-certification requirements.
• Maintains up-to-date documentation in the EMR on authorization approvals/denials.
• Assists with referrals and scheduling considerations when needed.
• Handles denial scenarios and coordinates with staff for potential appeals and resubmissions.
• Keeps current on payer guidelines for medically necessary authorizations and testing.

Skills

MS Word

Excel

Outlook

Customer service

Communication

Attention to detail

Problem solving

Medical terminology

Education

High School diploma or equivalent

Tools

MS Word

Excel

Outlook

Job description

OneOncology is seeking an Authorization Specialist to manage administrative tasks for outpatient diagnostic testing and procedure benefit verification. The role ensures insurance requirements are met before testing or procedures and secures pre-authorizations as needed.

Responsibilities include communicating with physicians, staff, and insurance coordinators, maintaining EMR documentation, and staying informed on payer guidelines.