Remote Clinical Prior-Authorization Specialist

The US Oncology Network; Henderson (NV); Remote; USD 52,000 - 76,000; Full time

Job summary

The US Oncology Network invites applications for a Remote Insurance Reviewer - Clinical (Treatment Prior Authorization Specialist) based in Southern Nevada. You will review orders for prior authorization, verify coverage, and coordinate with payers and treatment teams to ensure timely patient care in a fast-paced oncology setting.

Responsibilities include ensuring medical necessity, communicating payer requirements, and maintaining up-to-date knowledge of payer guidelines while working in a

Qualifications

• High school diploma or equivalent.
• Associates degree in Healthcare and LPN license preferred.
• Minimum three years medical insurance verification and authorization experience.
• Experience using electronic medical record portals.

Responsibilities

• Reviews, processes and audits the medical necessity for each patient’s external diagnostic order.
• Communicates with nursing and medical staff regarding restrictions or requirements in insurance plans.
• Updates coding/payer guidelines and records payer trends for office staff.
• Submits authorizations electronically via EMR payor portals and third-party portals.
• Acts as patient advocate and informs providers about denials and next steps.

Skills

Medical insurance verification

Authorization processing

Payer communications

Education

Associate degree in Healthcare

LPN license

Tools

EMR portals

Job description

The US Oncology Network invites applications for a Remote Insurance Reviewer - Clinical (Treatment Prior Authorization Specialist) based in Southern Nevada. You will review orders for prior authorization, verify coverage, and coordinate with payers and treatment teams to ensure timely patient care in a fast-paced oncology setting.

Responsibilities include ensuring medical necessity, communicating payer requirements, and maintaining up-to-date knowledge of payer guidelines while working in a