Autorization Specialist

Job Title: Authorization Specialist 
Department: Revenue Cycle Management 
Location: Carolina Oncology Specialists-Remote 
Reports To: Authorization Manager 

Position Summary 

The Authorization Specialist is responsible for obtaining and verifying prior authorizations for oncology services, including chemotherapy, radiation therapy, imaging, and supportive care. This role ensures timely approvals, minimizes treatment delays, and maintains compliance with payer requirements while supporting high-quality patient care. 

Key Responsibilities 

• Obtain prior authorizations for oncology treatments, procedures, medications, and diagnostic services in a timely manner 

• Review provider orders, treatment plans, and clinical documentation to ensure medical necessity and completeness prior to submission 

• Communicate with insurance companies, payers, and specialty pharmacies to secure approvals and document authorization details 

• Track authorization status and follow up to prevent delays in patient care 

• Collaborate with physicians, nurses, and clinical staff to resolve authorization issues or denials 

• Submit appeals and provide supporting documentation for denied services when appropriate 

• Maintain accurate and detailed records in the electronic health record (EHR) and/or practice management system 

• Verify insurance benefits, coverage limitations, and patient eligibility as needed 

• Ensure compliance with payer guidelines, regulatory requirements, and organizational policies 

• Identify trends in denials or delays and escalate issues to leadership for process improvement 

Qualifications 

Required: 

• High school diploma or equivalent 

• Minimum of 2–3 years of experience in healthcare prior authorizations, medical billing, or revenue cycle operations 

• Knowledge of insurance plans, including Medicare, Medicaid, and commercial payers 

• Experience working with EHR and practice management systems 

• Strong attention to detail and organizational skills 

Preferred: 

• Experience in oncology or specialty practice 

• Certification in medical billing/coding (e.g., CPC, CPAR, or similar) 

• Familiarity with chemotherapy regimens and oncology-specific authorization processes 

Key Competencies 

• Strong communication and interpersonal skills 

• Ability to manage multiple priorities in a fast-paced environment 

• Problem-solving and critical thinking 

• High level of accuracy and attention to detail 

• Customer service orientation with a patient-centered approach 

Working Conditions 

• Primarily office-based or remote work environment 

• Frequent use of computers, phones, and healthcare systems 

• May require extended periods of sitting and screen time 

Physical Requirements 

• Ability to sit for extended periods 

• Ability to use standard office equipment, including computers and telephones