Remote Clinical Prior Authorization Specialist

US Oncology Inc.; Henderson, Northern (NV, KY); Hybrid; USD 55,000 - 75,000; Full time

Job summary

Comprehensive Cancer Centers of Nevada seeks a Remote Insurance Reviewer - Clinical (Treatment Prior Authorization Specialist) to review orders for prior authorization and ensure timely patient care in Southern Nevada.

You will work with nursing and medical staff, submit authorizations through EMR payor portals, and advise on denials with next steps for providers, while upholding payer guidelines and HIPAA compliance.

Qualifications

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

Responsibilities

• Review medical necessity for external orders per plan and NCCN where needed.
• Inform nursing/medical staff of restrictions and payer requirements.
• Submit authorizations via EMR payor portals; maintain paperless workflows.
• Advise providers on denials and alternate steps.
• Keep up-to-date with payer guidelines and HIPAA regulations.

Skills

Medical insurance verification

Authorization processes

Education

High school degree or equivalent

Associates degree in Healthcare

LPN license and registration preferred

Tools

EMR portals

Job description

Comprehensive Cancer Centers of Nevada seeks a Remote Insurance Reviewer - Clinical (Treatment Prior Authorization Specialist) to review orders for prior authorization and ensure timely patient care in Southern Nevada.

You will work with nursing and medical staff, submit authorizations through EMR payor portals, and advise on denials with next steps for providers, while upholding payer guidelines and HIPAA compliance.