Remote Oncology Prior Authorization Specialist

Socket.dev; Henderson (NV); Remote; USD 55,000 - 90,000; Full time

Benefits offered by this job

Excellent benefits

Professional development

Nationwide network

Job summary

Comprehensive Cancer Centers of Nevada seeks a Remote Insurance Reviewer - Clinical to manage prior authorizations for diagnostic radiology, procedures and in-house treatments. You’ll work with providers and payers to obtain approvals, ensuring timely access to care for patients across Southern Nevada.

The role emphasizes accuracy, knowledge of payer guidelines and compliance with HIPAA. A strong background in medical insurance verification and EMR systems is required, with a flexible

Qualifications

• Minimum three (3) years of medical insurance verification and prior authorization experience.
• Experience using electronic medical record (EMR) portals.
• Associates degree in Healthcare preferred; high school diploma required.

Responsibilities

• Review, process and audit medical necessity for each patient's external diagnostic order.
• Communicate with nursing and medical staff regarding restrictions or special requirements and payer issues.
• Submit authorizations electronically using EMR payor portals and verify covered benefits.
• Act as patient advocate and liaison between patient and payer to resolve reimbursement questions.
• Maintain up-to-date knowledge of payer authorization requirements and compliance guidelines.

Skills

Medical insurance verification

Prior authorization

EMR portals

Healthcare workflows

Education

High school diploma or equivalent

Associates degree in Healthcare

LPN license (preferred)

Job description

Comprehensive Cancer Centers of Nevada seeks a Remote Insurance Reviewer - Clinical to manage prior authorizations for diagnostic radiology, procedures and in-house treatments. You’ll work with providers and payers to obtain approvals, ensuring timely access to care for patients across Southern Nevada.

The role emphasizes accuracy, knowledge of payer guidelines and compliance with HIPAA. A strong background in medical insurance verification and EMR systems is required, with a flexible