Specialty Authorization Coordinator for Infusion and Oncology - Remote in VirginiaA

Sentara Health

1d•Remote

About The Position

The Specialty Authorization Coordinator is responsible for securing prior authorizations for patient services that are complex in nature, specific to radiation oncology and series infusion patients. This role requires drug calculations and more significant research and review of clinical documentation while ensuring compliance with payer rules and policies. The role of the Specialty Authorization Coordinator involves collaborating with medical practice staff, providers and patients to facilitate the authorization, retro-authorization, and peer to peer process utilizing payer portals and automation tools effectively. The Specialty Authorization Coordinator maintains up-to-date knowledge of insurance plans and regulations and is adept in identifying patient insurance and benefits to streamline the authorization workflow.

Requirements

HS - High School Grad or Equivalent
Health Insurance Authorizations- 3 years REQUIRED
Strong attention to detail, follow up, organizational skills, and clear communication are essential to success in this role.

Nice To Haves

Prior experience in procedures/treatment plans/imaging preferred
Medical terminology and ICD-10 knowledge preferred

Responsibilities

Obtain and Verify Authorizations: Request and secure prior authorizations for procedures, diagnostic testing, hospital admissions, and specialty services according to payer requirements.
Insurance Verification: Confirm patient insurance eligibility, benefits, and coverage details to ensure services are authorized appropriately.
Documentation: Accurately record authorization numbers, payer requirements, and status updates in the electronic health record (EHR) or billing system.
Communication: Serve as a liaison between providers, patients, and insurance companies to clarify requirements and resolve authorization issues.
Follow-Up: Track pending authorizations, monitor turnaround times, and escalate delays to prevent service denials or scheduling disruptions.
Denial Prevention and Revenue Cycle Support: Review payer policies and authorization guidelines to reduce authorization-related claim denials. Partner with revenue integrity teams to resolve authorization-related denials.
Collaboration: Work closely with clinical staff, schedulers, and billing teams to ensure all necessary approvals are obtained prior to service delivery.
Confidentiality & Compliance: Adhere to HIPAA and organizational policies while handling sensitive patient and insurance information.

Benefits

Medical, Dental, Vision plans
Adoption, Fertility and Surrogacy Reimbursement up to $10,000
Paid Time Off and Sick Leave
Paid Parental & Family Caregiver Leave
Emergency Backup Care
Long-Term, Short-Term Disability, and Critical Illness plans
Life Insurance
401k/403B with Employer Match
Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
Student Debt Pay Down – $10,000
Reimbursement for certifications and free access to complete CEUs and professional development
Pet Insurance
Legal Resources Plan
Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.