Advanced Authorization Specialist

Advocate Health and Hospitals Corporation • Charlotte, NC

1d

About The Position

The Advanced Authorization Specialist obtains highly complex authorizations for a range of inpatient and outpatient services. The role requires a thorough understanding of commercial and government payors, coordination of benefits, authorization guidelines, pharmacy and medical benefit differences, and medical necessity policies. The specialist reads and interprets complex medical records to secure authorizations for requested services and treatment plans.

The position involves frequent communication with clinic staff, providers, pharmacists, and insurance companies to coordinate peer reviews, share updated medical and specialty-drug policies, and address appeals. The specialist also works with hospital and provider denial-management teams to review monthly denials, identify opportunities for retroactive authorizations, and determine root causes.

This is a full-time position, working Monday through Friday from 7:30 AM to 4:00 PM, 40 hours per week. There is an opportunity to work remotely after training. The listed pay range is $21.85–$32.80.

Requirements

• Bachelor's degree or 3 years of authorization experience.
• General knowledge and background in CPT and HCPCS coding.
• Proficiency with medical terminology and familiarity with clinical considerations related to oncology services.
• Excellent written and oral communication skills.

Nice To Haves

• Experience with Microsoft Excel, Word, and Epic.
• Experience with databases, hospital registration, billing, and clinical systems.

Responsibilities

• Assess time-sensitive referral work queues and obtain highly complex authorizations for inpatient and outpatient chemotherapy, oncology-related radiology, surgeries, molecular and genetic laboratory testing, specialty-related physical, occupational, and speech therapy, psychiatry, neuropsychological evaluations, and rehabilitation evaluations.
• Manage a high-volume STAT request mailbox for oncology facilities, processing requests for potentially life-altering, high-cost treatments and procedures, with expected treatment timelines of 1–3 days.
• Interpret medical records to assess initial diagnoses and disease progression, establish medical necessity for ordered services, and complete online clinical requests for advanced authorization.
• Manage the Atrium Health preferred drug list for chemotherapy, immunotherapy, and supportive drugs with payors, and coordinate changes with oncology pharmacy.
• Coordinate Atrium Health drug formulary changes with authorization updates at payors.
• Review laboratory panels for bone marrow biopsies to authorize diagnosis-specific molecular laboratory studies.
• Review and address monthly denials for chemotherapy drugs, molecular labs, and surgeries with payors and Atrium Health denial-management teams (HBO/PBO).

Benefits

• Paid time off programs.
• Medical, dental, vision, life, and short- and long-term disability benefits.
• Flexible spending accounts for eligible healthcare and dependent-care expenses.
• Adoption assistance and paid parental leave.
• Defined contribution retirement plans with employer match and other financial wellness programs.
• Educational Assistance Program.
• Career development programs.
• Premium pay, including shift and on-call pay, based on the position.
• Incentive pay for select positions.
• Opportunity for annual increases based on performance.

What This Job Offers

• Job Type: Full-time