Advanced Authorization Specialist

Advocate Health • Charlotte, NC

3d • $22 - $33 • Hybrid

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, including coordination of benefits, authorization guidelines, pharmacy and medical benefit differences, and medical necessity policies. The specialist reads and interprets complex medical records to obtain authorization for requested services and treatment plans.

The position communicates with clinic staff, providers, pharmacists, and insurance companies to coordinate peer reviews, share updated medical and specialty drug policies, and handle 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. The schedule is Monday through Friday, 7:30 a.m. to 4:00 p.m., with the opportunity to work remotely after training.

Requirements

• Bachelor's degree or three 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.
• Familiarity with databases, hospital registration, billing, and clinical systems.

Responsibilities

• Assess time-sensitive referral work queues and obtain complex authorizations for inpatient and outpatient chemotherapy, oncology-related radiology, surgeries, molecular and genetic laboratory testing, specialty physical and occupational therapy, speech therapy, psychiatry, neuropsychological evaluations, and rehabilitation evaluations.
• Manage a high-volume STAT request mailbox for oncology facilities, addressing potentially life-altering, high-cost treatments and procedures expected within one to three days.
• Interpret medical records to establish initial disease status and progression, demonstrate 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.
• Manage Atrium Health drug formulary changes by updating authorizations with payors.
• Review laboratory panels for bone marrow biopsies to authorize diagnosis-specific molecular lab 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 health care 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.
• Premium pay, including shift and on-call pay, for eligible positions.
• Incentive pay for select positions.
• Opportunity for annual increases based on performance.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level