Remote Prior Authorization Nurse Jobs in Silver Spring, MD

The Authorization Specialist is responsible for verifying patient insurance eligibility and benefits and obtaining required prior authorizations for Radiation Oncology services. This position works closely with clinical, scheduling, billing, and payer teams to ensure services are appropriately authorized prior to treatment and to minimize authorization-related delays and denials.

The ideal candidate is highly organized, detail-oriented, comfortable communicating with insurance companies, and able to manage multiple patients and authorization requirements simultaneously.

Essential Duties & Responsibilities

• Verify patient insurance eligibility and active coverage prior to services.
• Review insurance benefits and identify applicable coverage requirements for Radiation Oncology services.
• Determine whether prior authorization, pre-certification, notification, or referral is required based on the patient's payer and planned treatment.
• Submit authorization requests to commercial insurance companies, Medicare Advantage plans, Medicaid managed care plans, and other third-party payers as applicable.
• Obtain and submit required clinical documentation to support authorization requests.
• Track pending authorizations and perform timely follow-up with insurance companies to prevent treatment delays.
• Verify that authorization approvals accurately reflect the services/CPT codes, diagnosis, dates or date range, number of treatment fractions/units, and servicing/rendering providers or facilities requested.
• Identify authorization discrepancies and work with the payer and appropriate internal staff to resolve issues prior to treatment whenever possible.
• Monitor authorization expiration dates and approved treatment quantities and obtain extensions or additional authorization when necessary.
• Update authorizations when treatment plans change or additional services are ordered.
• Document authorization numbers, effective dates, approved services, payer contacts, reference numbers, and other pertinent information accurately within the appropriate system.
• Communicate authorization status, outstanding requirements, and potential coverage issues to clinical and scheduling teams.
• Escalate urgent or complex authorization issues that may impact scheduled treatment.
• Assist with authorization-related denials by researching authorization history and providing documentation needed for reconsideration or appeal.
• Maintain working knowledge of payer authorization requirements and changes that affect Radiation Oncology services.
• Maintain patient confidentiality and comply with HIPAA and organizational policies.

Qualifications

• High school diploma or equivalent required; associate degree or additional healthcare education preferred.
• 2+ years of experience with insurance verification, prior authorization, medical billing, or healthcare revenue cycle preferred.
• Radiation Oncology, Oncology, or specialty physician authorization experience strongly preferred.
• Knowledge of commercial insurance, Medicare Advantage, Medicaid, and other payer authorization processes.
• Familiarity with CPT and ICD-10 terminology and the ability to interpret treatment orders and authorization requirements.
• Experience working with payer portals and contacting insurance companies by phone.
• Experience with Epic, Aria or other electronic health record/practice management systems preferred.
• Strong organizational and follow-up skills with the ability to manage a high-volume workload.
• Excellent written and verbal communication skills.
• Strong attention to detail and ability to identify discrepancies before they result in treatment delays or claim denials.
• Ability to work independently while effectively collaborating with clinical and revenue cycle teams.

With a combined 40+ years of experience in billing and compliance, we have the knowledge and expertise to optimize our providers revenue cycle without compromise. We commit to providing an individualized approach to revenue cycle management, ensuring our service always meets our client's needs.