Pre-Authorization Specialist

Job Description

Job Description

Cancer Partners of Nebraska is seeking a detail-oriented and patient-focused Pre-Authorization Specialist to join our growing team. This role is essential to ensuring timely patient care by obtaining insurance authorizations, verifying benefits, coordinating services, and communicating effectively with patients, providers, and insurance carriers.

The ideal candidate is highly organized, thrives in a fast-paced environment, enjoys problem-solving, and is committed to delivering exceptional service to patients and colleagues.

The Pre-Authorization Specialist is responsible for obtaining prior authorizations and insurance approvals for procedures, diagnostic testing, medications, and treatments before services are rendered. This position works closely with physicians, nurses, referring clinics, scheduling teams, registration staff, and insurance carriers to ensure timely access to care and accurate documentation.

The specialist manages a high volume of inbound and outbound communication while maintaining accurate patient records and supporting efficient clinic operations.

• Verify patient insurance eligibility and benefits through electronic verification systems and direct communication with insurance carriers.
• Obtain prior authorizations and precertifications for services across Medical Oncology, Radiation Oncology, and Surgical Oncology.
• Ensure authorizations are secured for urgent and next-day services when required.
• Maintain accurate authorization documentation within the Electronic Medical Record (EMR) and Practice Management System.
• Communicate authorization status, updates, and payer requirements to nurses, providers, and other team members.
• Work directly with insurance companies and third-party organizations to obtain approvals and resolve authorization issues.
• Review denied services and assist with appeals or other resolution processes as appropriate.
• Utilize payer portals, electronic tools, telephone, fax, and other communication methods to efficiently manage workload.
• Coordinate with leadership and business office teams regarding payer policy updates, preferred product changes, and new service implementations.
• Communicate payer changes and authorization requirements that impact patient care and clinic operations.
• Participate in workflow improvements and process enhancement initiatives.
• Answer incoming telephone calls professionally and promptly.
• Perform additional duties and special projects as assigned.

• High school diploma or equivalent required.
• Medical office, coding, insurance, case management training, or equivalent experience preferred.
• Clinical or nursing education and experience preferred.

• Minimum of two years of experience in a medical office setting involving prior authorizations, insurance verification, billing, or related functions.
• Oncology experience preferred but not required.

• Strong understanding of medical insurance, benefit verification, and prior authorization processes.
• Working knowledge of ICD-10, CPT, and HCPCS coding concepts.
• Excellent verbal and written communication skills.
• Ability to manage a high volume of incoming and outgoing calls.
• Strong customer service orientation with a commitment to patient-centered care.
• Exceptional organizational skills and attention to detail.
• Ability to prioritize competing demands and meet deadlines.
• Proficiency with electronic medical records, practice management software, and Microsoft Office applications.
• Ability to work independently while contributing effectively as part of a team.

• Professional office environment that is well-lit and climate controlled.
• Frequent use of computers, telephones, and office equipment.
• Extended periods of sitting, standing, reading, and computer work.
• Regular communication with patients, providers, insurance carriers, and team members.
• Occasional stress associated with high-volume workloads and time-sensitive patient care needs.

At Cancer Partners of Nebraska, we are committed to providing exceptional cancer care through compassion, innovation, and teamwork. Every team member plays a vital role in supporting our patients throughout their treatment journey. If you are passionate about helping patients receive timely access to care and enjoy working in a collaborative healthcare environment, we encourage you to apply.

Cancer Partners of Nebraska is an Equal Opportunity Employer.