Prior Authorization Specialist

Schedule: Monday – Friday | 8:00 AM – 5:00 PM (Central Time)

Summit Specialty Care is seeking an experienced, highly organized, and detail-oriented Oncology Prior Authorization Specialist to join our growing healthcare team.

The ideal candidate will have a strong background in oncology prior authorizations, insurance verification, specialty medications, chemotherapy, immunotherapy, and medical necessity requirements.

This position plays a critical role in ensuring patients receive timely access to cancer treatments while maintaining accurate authorizations, minimizing insurance denials, and supporting efficient revenue cycle operations.

Oncology Prior Authorizations

Obtain and manage prior authorizations for chemotherapy, immunotherapy, biologics, injections, infusion therapies, and other oncology-related services.

Submit authorization requests through insurance portals, electronic systems, and direct payer communication.

Verify authorization requirements for medications, administration codes, treatment plans, and procedures.

Ensure authorizations accurately reflect HCPCS/J-codes, CPT codes, diagnosis codes, medication dosages, units, frequency, and approved treatment dates.

Monitor pending authorizations and follow up with insurance companies until a determination is received.

Track authorization expiration dates, approved units, and treatment cycles to prevent interruptions in patient care.

Insurance Verification and Medical Necessity

Verify insurance eligibility, benefits, coverage limitations, and payer-specific authorization requirements.

Review medical records, physician orders, pathology reports, clinical notes, and treatment plans to ensure all necessary documentation is available.

Identify payer medical necessity requirements and assist with obtaining additional documentation when needed.

Coordinate with clinical staff and providers to resolve missing or incomplete information.

Denials, Appeals, and Follow-Up

Investigate denied or delayed authorizations and determine appropriate corrective actions.

Prepare and submit authorization reconsiderations and appeals with supporting clinical documentation.

Coordinate peer-to-peer reviews between providers and insurance medical directors.

Maintain accurate documentation of payer communications, reference numbers, authorization decisions, and follow-up activity.

Department Coordination and Reporting

Communicate authorization status to scheduling, nursing, pharmacy, billing, and management teams.

Ensure patients are properly cleared before treatment is scheduled or administered.

Maintain accurate authorization tracking reports and provide regular updates on pending, approved, and denied