Oncology Authorization Specialist

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 <div