Job Description

Job Title: Authorization Specialist

Location: Miami (Not remote)

Department: Oncology

Reports To: Oncology Authorization Manager

Job Type: Full-time

Position Summary:

The Oncology Authorization Specialist is responsible for coordinating and obtaining prior authorizations related to hematology/oncology treatments, medications and services. This position ensures that all required documentation is completed, submitted, and approved in a timely manner to support uninterrupted patient care. The specialist works closely with providers, clinical staff, and insurance companies to ensure optimal treatment plans and financial feasibility.

Key Responsibilities:

• Initiate and follow through on prior authorization requests for oncology treatments, medications and services with insurance providers
• Verify insurance coverage and benefits for oncology services, including chemotherapy and specialty medications.
• Work closely with physicians, nurses, pharmacy techs, and other staff to gather required clinical documentation.
• Communicate with insurance payers, patients, and healthcare providers to ensure timely authorization approvals and address any issues.
• Ensure authorizations and referrals are obtained for all necessary procedures, medications, and services.
• Accurately enter patient insurance, authorization, and billing information into the electronic medical records (EMR) / billing systems.
• Track and follow up on pending authorizations and appeal denials when appropriate.
• Maintain accurate records of authorization requests, approvals, and denials.
• Accurately document all communications and updates in electronic health records (EHR) or practice management systems.
• Coordinate with physicians and clinical staff to ensure proper documentation for medical necessity.
• Assist patients with understanding their financial responsibilities and connecting them with financial resources.
• Maintain up-to-date knowledge of insurance payer requirements, including Medicare, Medicaid, and commercial insurers.
• Maintain compliance with HIPAA and other regulatory requirements.

Qualifications:

• High school diploma or equivalent required; Associates or Bachelor's degree preferred.
• Minimum of 2 years of experience in medical insurance authorization, preferably in oncology clinic setting.
• Strong knowledge of oncology-related terminology, treatments, and billing codes (ICD-10, CPT, HCPCS).
• Familiarity with electronic medical records (EMR) and practice management systems.
• Excellent communication, organizational, and problem-solving skills.
• Ability to manage multiple tasks and work under pressure in a fast-paced, patient-focused environment.

• Understanding of healthcare insurance processes and guidelines.

Preferred Qualifications:

• Certification in medical billing or coding (e.g., CPC, CMC, CMRS)
• Experience with Medicare, Medicaid, and commercial insurance payers.
• Knowledge of oncology treatment protocols and drug regimens.
• Bilingual (Spanish or Creole) a plus.

Salary:

$22 -$25

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