Chemotherapy Authorization Specialist

The US Oncology Network•Philadelphia, PA

5d•Onsite

About The Position

Alliance Cancer Specialists is seeking a Chemotherapy Authorization & Reimbursement Specialist to support insurance verification, prior authorization, and reimbursement activities across our oncology practices. This role will be located in our Administrative Office in Trevose,PA.. This role is responsible for reviewing medical necessity documentation, obtaining chemotherapy authorizations, researching denied services, and coordinating with payers, patients, and clinical staff to ensure timely and accurate reimbursement for oncology services. The ideal candidate is detail‑oriented, highly organized, and comfortable working independently in a fast‑paced healthcare environment, with a strong understanding of chemotherapy authorization requirements, payer guidelines, and regulatory compliance. This position supports and adheres to the US Oncology Compliance Program, including the Code of Ethics and Business Standards, and ensures all authorization and reimbursement activities are performed in accordance with applicable state and federal regulations, payer policies, and organizational standards.

Requirements

High school diploma or equivalent required
Minimum of two (2) years of experience in medical insurance verification and authorization required

Nice To Haves

Associate’s degree in Healthcare preferred
Billing and coding experience preferred
Oncology or chemotherapy authorization experience strongly preferred

Responsibilities

Review, process, and audit medical necessity documentation for each patient’s chemotherapy treatment, including regimen accuracy and pathway adherence.
Obtain insurance authorizations and pre-certifications for chemotherapy services; proactively address coverage limitations to prevent delays or denials.
Serve as a patient advocate and liaison between patients and payers to resolve reimbursement questions and insurance-related issues.
Research alternative funding or assistance resources for non-covered services, including pharmaceutical programs, community resources, and financial assistance options.
Communicate insurance requirements, restrictions, and payer-specific guidelines to physicians, nursing staff, and management in a timely manner.
Provide feedback regarding pathway documentation issues, non-covered chemotherapy drugs, and payer trends.
Prepare and submit write-off requests with appropriate supporting documentation.
Process insurance and patient correspondence, including denial follow-up, adjustments, refunds, and negotiated agreement reviews.
Maintain accurate reimbursement correspondence and filing systems.
Assist with financial disclosure reviews and provide coverage support for Patient Financial Counselors as needed.
Maintain up-to-date knowledge of chemotherapy authorization requirements, payer policies, and state and federal regulatory guidelines.
Ensure compliance with patient confidentiality laws and regulations, including HIPAA.
Update coding and payer guidelines for clinical staff and track treatment pathways.
Perform additional business office and administrative duties as assigned.