Authorization and Referral Specialist – Radiation Oncology

Description Position Summary The Authorization and Referral Specialist is responsible for obtaining insurance authorizations, managing referrals, and ensuring timely approval of radiation oncology treatments, diagnostic testing, procedures, and related services. This role acts as a liaison between patients, providers, insurance companies, and clinical staff to minimize delays in care and ensure compliance with payer requirements. The specialist supports the revenue cycle by verifying benefits, securing authorizations, and maintaining accurate documentation within the electronic medical record (EMR). Florida Urology Partners offers a wealth of benefits for our full-time employees including a membership to the YMCA! Essential Duties and Responsibilities Insurance Authorization Management · Obtain prior authorizations for radiation therapy, simulations, treatment planning, diagnostic imaging, laboratory services, and related oncology procedures. · Review physician orders, treatment plans, and clinical documentation to determine authorization requirements. · Submit authorization requests to commercial insurance companies, Medicare Advantage plans, Medicaid managed care organizations, and other payers. · Track authorization status and follow up with payers to ensure timely approvals. · Manage concurrent reviews, authorization extensions, and treatment modifications as needed. · Maintain detailed records of authorization numbers, approval dates, units approved, and expiration dates. Referral Coordination · Process incoming and outgoing referrals in accordance with payer and organizational requirements. · Verify referral accuracy and completeness prior to scheduling services. · Coordinate referrals with primary care physicians, specialists, hospitals, and external facilities. · Ensure all required clinical documentation accompanies referral requests. Insurance Verification · Verify patient eligibility, benefits, coverage limitations, deductibles, copayments, and coinsurance responsibilities. · Identify authorization requirements and coverage restrictions before patient services are rendered. · Communicate authorization-related updates to patients and clinical staff. Patient and Provider Communication · Serve as a point of contact for providers, care teams, and insurance representatives regarding authorization and referral matters. · Communicate authorization denials, delays, and appeals requirements to physicians and office teams. Appeals and Denials Management · Assist with peer-to-peer reviews and appeals for denied services. · Gather supporting clinical documentation for reconsiderations and medical necessity reviews. Documentation and Compliance · Document all authorization, referral, and payer communications accurately within the EMRs Epic and Aria. · Maintain compliance with CMS regulations, payer guidelines, HIPAA requirements, and organizational policies. · Ensure confidentiality of patient information at all times. Collaboration and Operational Support · Work closely with radiation oncologists, dosimetrists, physicists, nurses, therapists, schedulers, and revenue cycle teams. · Participate in process improvement initiatives focused on reducing treatment delays and improving patient access to care. Requirements Required Qualifications High school diploma or GED required; Associate degree preferred. Knowledge of commercial, Medicare, Medicaid, and managed care payer requirements. Proficiency with electronic medical records (EMR) and practice management systems. Insurance and authorization expertise· Strong organizational, multitasking, and problem-solving skills. Minimum of 2 years of successful experience working independently in a healthcare, revenue cycle, authorization, referral, or patient access role. Demonstrated ability to meet productivity, quality, and turnaround-time expectations while working remotely. Proficiency with remote access technologies, virtual private networks (VPNs), electronic medical records (EMR), payer portals, Microsoft Office applications, and collaboration tools such as Microsoft Teams. Strong written and verbal communication skills with the ability to effectively communicate with patients, providers, insurance representatives, and team members in a virtual environment. Ability to prioritize tasks, manage multiple work queues, and maintain organization with minimal direct supervision. Dedicated home workspace that provides privacy for handling Protected Health Information (PHI) and confidential information in compliance with HIPAA regulations. Reliable high-speed internet connection capable of supporting secure remote access and video conferencing. Ability to maintain regular attendance, adhere to scheduled working hours, and participate in virtual meetings and training sessions. Remote Work Competencies Self-motivation and accountability Attention to detail and accuracy Time management and prioritization· Independent problem-solving· Adaptability and flexibility Virtual collaboration and teamwork Customer service excellence· Ability to maintain productivity in a remote setting Ability to work in a fast-paced oncology environment Preferred Qualifications Experience with radiation oncology treatment authorizations, including IMRT, SBRT, SRS, brachytherapy, and diagnostic imaging. Knowledge of CPT, ICD-10, HCPCS, and medical necessity guidelines. Previous remote experience in oncology, radiation oncology, specialty care authorizations, or healthcare revenue cycle operations. Experience working with multiple EMR systems and payer portals in a remote environment. Demonstrated success managing high-volume authorization and referral workloads independently. Knowledge of cybersecurity best practices and HIPAA requirements for remote healthcare employees. Florida Urology Partners is committed to diversity and does not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.