Job Title: Prior Authorization Specialist – Specialty Medications & Infusion

Location: Knoxville, TN (100% On-site)

Pay Rate: $21.00 – $25.00/hour (Based on experience)

Schedule: Full-Time, Monday – Friday | Choice of shift (7:30 AM–4:00 PM, 8:00 AM–4:30 PM, or 8:30 AM–5:00 PM)

Position Type: Contract-to-Hire

Position Overview

We are seeking an experienced Prior Authorization Specialist with a strong background in pharmaceutical and specialty drug authorizations to join a dedicated Centralized Business Office (CBO) team in Knoxville. In this high-impact role, you will be directly responsible for securing timely coverage for complex medical specialty drugs, chemotherapy, and infusion regimens—ensuring patients receive critical treatments without delay.

The ideal candidate brings deep expertise in navigating payor portals, reviewing clinical documentation for medical necessity, and overcoming payor barriers such as white-bagging mandates and peer-to-peer requirements.

Key Responsibilities

• Specialty Drug Authorizations: Initiate, track, and secure timely prior authorizations for complex specialty medications, chemotherapy, and infusion regimens.

• Clinical Submission & Medical Necessity: Submit comprehensive clinical documentation (physician notes, lab results, diagnosis codes, regimen details) to payors to justify treatment necessity.

• Payor Portal & Workflows: Navigate major regional payor portals and phone lines (BlueCross ~30%, Medicare/Medicare Advantage ~30%, Humana, etc.) using platforms like Availity and CoverMyMeds.

• Appeals & White-Bagging Navigation: Manage appeals and peer-to-peer workflows to navigate payor white-bagging mandates and protect in-house buy-and-bill operations.

• Interdepartmental Liaison: Serve as the primary contact between the CBO, attending physicians, and clinic staff regarding payor restrictions and authorization status updates.

Required Qualifications

• Experience: Minimum 2+ years of direct healthcare insurance verification and prior authorization experience.

• Pharmaceutical Focus: Proven experience obtaining prior authorizations specifically for medications and specialty drugs (experience limited to diagnostic imaging or basic procedures will not qualify).

• Coding Knowledge: Working knowledge of ICD-10, CPT, and HCPCS coding as it relates to drug medical necessity and payor guidelines.

• Portal Proficiency: Strong hands-on experience utilizing major payor portals (Availity, CoverMyMeds, and payor-specific sites).

• Core Attributes: High accuracy, urgency, strong problem-solving skills, and proactive communication.

Preferred Qualifications

• Direct prior authorization experience in Oncology, Hematology, Chemotherapy, or Specialty Infusion.

• Experience operating within Athena IDX.

• Background as a Certified Medical Assistant (CMA), Licensed Practical Nurse (LPN), or Healthcare Financial Counselor.

Why Join Us?

• Flexible Work Hours: Choose the schedule that best fits your lifestyle (7:30 AM, 8:00 AM, or 8:30 AM start times).

• Meaningful Impact: Play a critical role in patient care by ensuring immediate access to lifesaving cancer and specialty treatments.

• Career Growth: Direct contract-to-hire pathway into a premier regional healthcare group.

• Equipment Provided: Full hardware setup provided on-site.

  Job Title: Prior Authorization Specialist – Specialty Medications & Infusion

  Location: Knoxville, TN (100% On-site)

  Pay Rate: $21.00 – $25.00/hour (Based on experience)

  Schedule: Full-Time, Monday – Friday | Choice of shift (7:30 AM–4:00 PM, 8:00 AM–4:30 PM, or 8:30 AM–5:00 PM)

  Position Type: Contract-to-Hire

  Position Overview

  We are seeking an experienced Prior Authorization Specialist with a strong background in pharmaceutical and specialty drug authorizations to join a dedicated Centralized Business Office (CBO) team in Knoxville. In this high-impact role, you will be directly responsible for securing timely coverage for complex medical specialty drugs, chemotherapy, and infusion regimens—ensuring patients receive critical treatments without delay.

  The ideal candidate brings deep expertise in navigating payor portals, reviewing clinical documentation for medical necessity, and overcoming payor barriers such as white-bagging mandates and peer-to-peer requirements.

  Key Responsibilities

• Specialty Drug Authorizations: Initiate, track, and secure timely prior authorizations for complex specialty medications, chemotherapy, and infusion regimens.

• Clinical Submission & Medical Necessity: Submit comprehensive clinical documentation (physician notes, lab results, diagnosis codes, regimen details) to payors to justify treatment necessity.

• Payor Portal & Workflows: Navigate major regional payor portals and phone lines (BlueCross ~30%, Medicare/Medicare Advantage ~30%, Humana, etc.) using platforms like Availity and CoverMyMeds.

• Appeals & White-Bagging Navigation: Manage appeals and peer-to-peer workflows to navigate payor white-bagging mandates and protect in-house buy-and-bill operations.

• Interdepartmental Liaison: Serve as the primary contact between the CBO, attending physicians, and clinic staff regarding payor restrictions and authorization status updates.

• Experience: Minimum 2+ years of direct healthcare insurance verification and prior authorization experience.

• Pharmaceutical Focus: Proven experience obtaining prior authorizations specifically for medications and specialty drugs (experience limited to diagnostic imaging or basic procedures will not qualify).

• Coding Knowledge: Working knowledge of ICD-10, CPT, and HCPCS coding as it relates to drug medical necessity and payor guidelines.

• Portal Proficiency: Strong hands-on experience utilizing major payor portals (Availity, CoverMyMeds, and payor-specific sites).

• Core Attributes: High accuracy, urgency, strong problem-solving skills, and proactive communication.

• Preferred Qualifications

• Direct prior authorization experience in Oncology, Hematology, Chemotherapy, or Specialty Infusion.

• Experience operating within Athena IDX.

• Background as a Certified Medical Assistant (CMA), Licensed Practical Nurse (LPN), or Healthcare Financial Counselor.

• Why Join Us?

• Flexible Work Hours: Choose the schedule that best fits your lifestyle (7:30 AM, 8:00 AM, or 8:30 AM start times).

• Meaningful Impact: Play a critical role in patient care by ensuring immediate access to lifesaving cancer and specialty treatments.

• Career Growth: Direct contract-to-hire pathway into a premier regional healthcare group.

• Equipment Provided: Full hardware setup provided on-site.

^*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).

^*As a job position within our Revenue Cycle 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: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. 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.