Job Summary
Our client is seeking an experienced Prior Authorization Specialist to support their onsite infusion and oncology services. This role involves obtaining insurance authorizations for infusion therapies, oncology treatments, and related services to ensure timely access to care and proper reimbursement. The candidate will work in a fast-paced clinical environment and collaborate closely with providers, pharmacists, nurses, and billing teams.
Key Responsibilities
- Review provider orders and clinical documentation for accuracy and completeness.
- Submit prior authorization requests to commercial and government payers.
- Monitor authorization status via payer portals and direct communication with insurance representatives.
- Manage follow-ups, resolve authorization delays, and assist with denials and appeals by gathering supporting clinical documentation.
- Document authorization details, approvals, and expirations accurately in electronic health records and billing systems.
Qualifications
- Strong knowledge of infusion and oncology workflows, medical and pharmacy benefits, and payer requirements for high-cost injectable and infused medications.
- Excellent attention to detail, strong organizational and communication skills.
- Ability to prioritize multiple authorization requests to meet treatment schedules.
- Familiarity with CPT, ICD-10, HCPCS codes, and oncology-related prior authorization requirements is a plus.
Experience
- Minimum 2 years of experience in Prior Authorization.
- Prior experience or skills in infusion, oncology, specialty pharmacy, or healthcare revenue cycle is preferred.
Skills
- Knowledge of insurance.
- Experience in an oncology office is preferred.
Benefits
- Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
- Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
- 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
- Short Term Disability Insurance.
- Term Life Insurance Plan.
Required Employment / Compliance Language
In compliance with state and local laws, all qualified applicants will receive consideration for employment without regard to age, race, color, sex, sexual orientation, gender identity, religion, national origin, disability, or veteran status.
*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
Medix Overview:
With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.
*As a job position within our Clinical Sciences division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: high-risk working environments (laboratories, clinical settings), handling hazards chemicals or lab specimens, conducting direct patient care, accessing medical and confidential records, access to prescription medication or other drugs, and job duties that can cause serious injury or death as a result of error. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
