Senior Authorization & Reimbursement Specialist

Astera Cancer Care; Nashville (TN); On-site; USD 45,000 - 65,000; Full time

Job summary

OneOncology is seeking a Sr. Authorization Specialist to support pre-authorizations for treatments and procedures, ensuring insurance requirements are met for reimbursement.

You will collaborate with physicians, nurses, social workers, and the authorization team to maintain up-to-date EMR documentation and address denials. Responsibilities include coordinating with vendors, updating referrals, handling denials with rescheduling or peer-to-peer review, and staying current with carrier

Qualifications

• High school diploma or GED required.
• Two years experience in a directly related role preferred, but not required.

Responsibilities

• Supports the team responsible for obtaining pre-authorizations for Physician Orders for treatments or procedures as required by the patient’s insurance carrier.
• Engages with authorization vendors on quality and production.
• Communicates with authorization team members, physician/clinical staff on reimbursement issues and/or pre-certification requirements by the patient’s insurance carriers.
• Ensures up-to-date documentation on patient’s accounts in Electronic Medical Record and Practice Management System on authorization approvals and denials.
• Communicates with practice staff when the need for updated referrals arise.
• Communicates with practice staff in the case of denials that will require rescheduling and/or peer- to-peer review by the ordering physician.
• Communicates with hospitals or other diagnostic facilities to correct any discrepancies.
• Contacts practices staff to notify of termed insurances.
• Communicates as necessary and in a timely fashion with the practice staff with regards to the status of pending authorizations.
• Keeps current on insurance carrier requirements for treatments and procedures.
• Follows policy and procedures outlined by management to ensure standardization of processes across the clinics.
• Works with the Account Receivable Team on denials and complete retro authorization requests and or medically necessary appeals.

Skills

Customer service

Communication

Problem solving

Multi-tasking

Attention to detail

Team collaboration

MS Word

Excel

Outlook

Data handling

Education

High school diploma or GED

Tools

MS Word

Excel

Outlook

Job description

OneOncology is seeking a Sr. Authorization Specialist to support pre-authorizations for treatments and procedures, ensuring insurance requirements are met for reimbursement.

You will collaborate with physicians, nurses, social workers, and the authorization team to maintain up-to-date EMR documentation and address denials. Responsibilities include coordinating with vendors, updating referrals, handling denials with rescheduling or peer-to-peer review, and staying current with carrier