Job Description

Columbus Oncology and Hematology Associates is currently searching for a talented individual to join our prior authorization team located in Dublin. Our mission is to improve the lives of those with cancer and blood disorders. We provide a wonderful work environment and corporate culture. In addition, we pride ourselves on offering a comprehensive benefits package, competitive pay, and we value work-life balance for our staff members.

The Senior  Precertification Specialist will complete the duties of the Precertification Specialists, as well as the following...

• Advanced Case Management: Analyze complex prior authorization cases, proactively identifying potential coverage challenges and working with payers to secure timely approvals.
• Leadership & Mentorship: Serve as a resource for junior team members, providing guidance on payer policies, medical necessity reviews, and best practices. Assist in training new employees.
• Process Optimization: Identify inefficiencies in prior authorization workflows and collaborate with leadership to implement process improvements that support faster authorizations and reduce denials.
• Interdepartmental Collaboration: Act as a liaison between the precertification team, clinical staff, billing department, and scheduling teams, ensuring smooth communication and coordination for authorization-related matters.
• Compliance & Policy Adherence: Maintain up-to-date knowledge of payer policies, Medicare guidelines, and NCCN protocols. Provide recommendations on adjustments to internal procedures to maintain compliance.
• Escalation & Resolution: Handle escalated cases requiring appeals, medical director reviews, and direct payer negotiations for high-priority authorization requests.

Qualifications:

• 3–5 years' experience in a physician practice or healthcare setting performing prior authorization activities, with oncology experience preferred, specifically oncology nursing. 
• Extensive knowledge of health insurance regulations, including payer-specific authorization policies.
• Proficiency in ICD-10 and CPT coding, with demonstrated expertise in oncology-related coding and medical necessity review.
• Advanced proficiency in EMR systems, practice management software, and Microsoft Office applications (Outlook, Word, Excel).
• High school diploma or GED required; additional certification in medical billing, coding, or healthcare administration preferred.

Columbus Oncology Associates is an Equal Opportunity Employer and proudly a Drug-Free Workplace.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. 

Job Tags

Full time, Work at office,

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