Cancer Care Authorization Specialist

Urology America, MSO • Austin, TX

5d • Onsite

About The Position

The Cancer Care Authorization Specialist is a critical member of the patient care team, specifically focused on securing access to life-saving treatments for Urology Austin’s oncology patients. This role specializes in navigating the complex prior authorization (PA) landscape for bladder cancer medications (including immunotherapy, chemotherapy, and intravesical therapies), and high-cost procedures. The primary goal is to eliminate financial and administrative barriers to care by ensuring accurate, timely insurance approvals in accordance with practice policy and payer guidelines.

Requirements

• High school diploma required; Associate or Bachelor’s degree in Healthcare Administration or related field preferred.
• Minimum 2 years of medical insurance authorization experience. Oncology or Specialty Pharmacy experience is highly preferred.
• Proficiency in Allscripts or Urochart preferred. Deep understanding of CPT, HCPCS (J-codes), and ICD-10 coding specific to urology and oncology.
• Exceptional ability to communicate sensitive financial and clinical information to patients, providers, and insurance adjusters.
• Strong grasp of NCCN (National Comprehensive Cancer Network) guidelines or general oncology authorization workflows.
• Ability to research drug use policies and find pathways for approval through Patient Assistance Programs (PAPs) or foundations if insurance denies coverage.
• High accuracy in calculating patient cost-shares and ensuring "units" authorized match the prescribed dosage.
• Understanding that delays in authorization can directly impact a cancer patient's clinical outcome.
• Primarily office setting (80% sitting/computer work).
• High. Requires the ability to remain calm and professional while dealing with high-stakes medical timelines and tense interactions with insurance payers.
• Ability to lift up to 20 lbs; frequent use of dual-monitor computer setups and multi-line phone systems.

Nice To Haves

• Oncology or Specialty Pharmacy experience is highly preferred.
• Proficiency in Allscripts or Urochart preferred.
• Associate or Bachelor’s degree in Healthcare Administration or related field preferred.

Responsibilities

• Authorization Management: Proactively manage authorizations for complex bladder cancer drug regimens (e.g., BCG, Gemcitabine, Mitomycin, and advanced immunotherapies).
• Payer Navigation: Verify patient eligibility and benefits; navigate specialized oncology medical policies to ensure clinical criteria are met for "High Risk-High Cost" medication and procedure approvals.
• Clinical Liaison: Review provider notes and pathology reports to extract necessary clinical documentation (ICD-10/CPT codes) required to justify medical necessity to insurance carriers.
• Financial Counseling Support: Update the "Insurance Verification Sheet" (IVS) with precise detail on deductibles, co-insurance, and out-of-pocket maximums; scan all approvals into the EMR (Allscripts/Urochart) to prevent claim denials.
• Appeals & Peer-to-Peer Coordination: Identify and initiate clinical appeals for denied authorizations; coordinate "Peer-to-Peer" reviews between Urology Austin physicians and insurance medical directors.
• Data Integrity: Maintain meticulous records in the EMR to track authorization expiration dates and "units" used to ensure continuous, uninterrupted treatment cycles for cancer patients.
• Cross-Functional Support: Assist with authorizations for general urology procedures (Pellets, Imaging, etc.) and perform other duties as assigned to support the Revenue Cycle team.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 51-100 employees