Senior Oncology Authorization Specialist

Advocate Health; Charlotte (NC); On-site; USD 65,000 - 85,000; Full time

Job summary

Advocate Health is seeking an Advanced Authorization Specialist to secure highly complex authorizations for inpatient and outpatient oncology services. You will interpret complex medical records, coordinate with clinic staff, physicians, pharmacists and insurers, and ensure timely, accurate submissions.

The role requires strong knowledge of CPT/HCPCS coding, medical terminology, and experience with payer policies.

Qualifications

• Bachelor's Degree or 3 years of authorization experience required.
• Proficiency in CPT/HCPCS coding and medical terminology.
• Strong written and oral communication skills; Excel, Word, and Epic experience preferred.

Responsibilities

• Assess time-sensitive Referral Work Queues to obtain highly complex authorizations including IP/OP Chemotherapy, Radiology, Oncology treatment plans, IP/OP Surgeries, Molecular and Genetic Laboratory Testing, PT/OT and Speech Therapy, Psychiatry, Neuro/Psych Evaluations, and Rehab evaluations.
• Manage high-volume Stat request mailbox for all oncology facilities with a 1–3 day turnaround.
• Interpret medical records to determine medical necessity and complete online clinical requests for advanced authorization.
• Manage Atrium Health preferred drug list with payors and correlate changes with oncology pharmacy.
• Review laboratory panels for Bone Marrow Biopsies to authorize Molecular Lab Studies.
• Review and address monthly denials for Chemotherapy Drugs, Molecular Labs and surgeries with payors and Atrium Health Denial Management Teams (HBO/PBO).

Skills

CPT/HCPCS coding

Medical terminology

Written & verbal communication

Billing systems

Microsoft Excel/Word

Education

Bachelor's Degree

Authorization experience

Tools

Epic

Job description

Advocate Health is seeking an Advanced Authorization Specialist to secure highly complex authorizations for inpatient and outpatient oncology services. You will interpret complex medical records, coordinate with clinic staff, physicians, pharmacists and insurers, and ensure timely, accurate submissions.

The role requires strong knowledge of CPT/HCPCS coding, medical terminology, and experience with payer policies.