Prior Authorization Specialist

Southwest Women's Oncology + Optimum Infusion | Albuquerque, New Mexico

A patient with a cancer diagnosis should not have to wait for treatment because the paperwork wasn't handled correctly.

Prior authorization is one of the most consequential administrative functions in oncology and infusion care. When it works - done completely, submitted correctly, followed up on relentlessly-patients get to their infusion chair, operating room, and medication on time. When it doesn't, care is delayed, revenue is lost, and the clinical team absorbs friction that shouldn't exist.

Southwest Women's Oncology (SWWO) is New Mexico's leading gynecologic oncology practice, delivering advanced cancer care with skill, courage, and compassion.

Optimum Human and Optimum Infusion extend that mission into performance medicine, infusion services, longevity, recovery, hormone optimization, medical weight loss, peptide therapies, hyperbaric medicine, aesthetics, and human performance.

Together, we operate as a single integrated platform committed to one mission:

To deliver new possibilities in medical care, human performance, and health by uniting passion, knowledge, and precision into something greater than the sum of its parts.

The Prior Authorization Specialist is responsible for obtaining timely insurance authorizations for clinic-based services-including infusion therapies such as chemotherapy, immunotherapy, and biologics; surgical procedures; and oral and specialty medications-ensuring patients receive medically necessary care without delays.

You will work closely with:

• Providers and clinical staff on order review, documentation completeness, and peer-to-peer coordination
• Nurses and infusion schedulers to ensure authorizations are secured prior to every treatment appointment
• Surgery schedulers on surgical authorization timelines and operative plan documentation
• Pharmacy on specialty medication authorization and oral oncology coordination
• Billing and coding staff to ensure authorized services align with CPT, HCPCS, and ICD-10 requirements

Your accuracy, urgency, and follow-through directly determine whether patients get to their care on time.

• Obtain prior authorizations for infusion therapies (chemotherapy, immunotherapy, biologics, and supportive medications), surgical procedures, and oral and specialty medications.
• Submit authorization requests via payer portals, electronic systems, phone, and fax with complete and payer-compliant documentation.
• Track authorization status across all active requests and proactively follow up with insurance carriers to secure timely determinations.
• Ensure authorizations are in place prior to scheduled infusion appointments, clinic visits, surgeries, and medication dispensing-without exception.

• Review provider orders, clinical notes, operative plans, and supporting documentation to ensure completeness and payer compliance before submission.
• Verify insurance benefits, coverage criteria, and payer-specific requirements including step therapy, site-of-care rules, and clinical guidelines.
• Maintain accurate, up-to-date documentation in the EMR and authorization tracking systems.
• Stay current on payer policies, clinic workflows, and regulatory standards impacting outpatient services.

• Communicate authorization approvals, denials, and pending requirements to providers, nurses, surgery schedulers, pharmacy, and front-desk teams in a timely and clear manner.
• Coordinate peer-to-peer reviews and appeal processes with providers and leadership when authorizations are denied or delayed.
• Collaborate with billing and coding staff to ensure authorized services align with CPT, HCPCS, ICD-10 codes, and payer requirements.
• Maintain strict compliance with HIPAA, organizational policies, and payer regulations at all times.

• Independently managing the full authorization workflow for infusion, surgical, and medication services.
• Zero preventable care delays due to missing or late authorizations.
• Strong working relationships established with clinical, scheduling, pharmacy, and billing teams.

• Recognized as a reliable, high-accuracy resource across the clinical and administrative team.
• Proactively identifying payer policy changes and surfacing authorization risks before they impact patient care.

• Viewed as a culture…