Advance Authorization Specialist

Position Overview Department: 09124 GCMG Infusion Operations: Administration – Administration Operations Status: Full time Benefits Eligible: Yes Hours Per Week: 40 Schedule: Monday-Friday 07:30-16:00 Pay Range $21.85 - $32.80 Major Responsibilities Assess time-sensitive referral work queues to obtain complex authorizations for oncologic treatments, including IP/OP chemotherapy, radiology studies, surgeries, molecular and genetic laboratory testing, specialty PT/OT and speech therapy, psychiatry, neuro/psychiatric evaluations, and rehab evaluations. Manage high-volume stat request mailbox for all oncology facilities, ensuring life-altering, high-cost treatments and procedures are authorized within a short time frame (1‑3 days). Interpret medical records to determine disease progression and prove medical necessity for ordered services; complete online clinical requests for advanced authorization. Administer Advocate Health preferred drug list (chemotherapy/immunotherapy/supportive drugs) with payors and coordinate changes with the oncology pharmacy. Process Advocate Health drug formulary changes and ensure authorization updates with payors. Review laboratory panels for bone marrow biopsies to authorize molecular lab studies specific to diagnoses. Review and address monthly denials for chemotherapy drugs, molecular labs, and surgeries with payors and Advocate Health denial management teams (HBO/PBO). Minimum Job Requirements Education: Bachelor's Degree or 3 years of authorization experience required. Work Experience: Bachelor's Degree or 3 years of authorization experience required. Knowledge / Skills / Abilities General knowledge and background in CPT and HCPCS coding. Proficiency with medical terminology and understanding of clinical considerations in oncology services. Excellent written and oral communication skills. Microsoft Excel, Word, Epic experience preferred. Experience with databases, hospital registration, billing, and clinical systems preferred. Physical Requirements Work requires typing, filing, use of the telephone, prolonged sitting, and the ability to bend and lift up to 10 lbs. Benefits and Compensation Base compensation within the listed pay range based on qualifications, skills, experience, and training. Premium pay such as shift and on‑call compensation. Incentive pay for select positions. Opportunity for annual increases based on performance. Paid time off programs. Health, dental, vision, life, short- and long-term disability benefits. Flexible Spending Accounts for eligible health care and dependent care expenses. Family benefits such as adoption assistance and paid parental leave. Defined contribution retirement plans with employer match. Financial wellness programs. Educational assistance program. Disclaimer All responsibilities and requirements are subject to possible modification to reasonably accommodate individuals with disabilities. This job description in no way states or implies that these are the only responsibilities or duties to be performed by an employee occupying this job or position. Employees must follow any other job-related instructions and perform any other job-related duties requested by their leaders. #J-18808-Ljbffr 271 Atrium Health Specialty Network, Inc