Prior Authorization Specialist

Summit Specialty Care – Oklahoma

Job Type: Full-Time

Schedule: Monday – Friday | 8:00 AM – 5:00 PM (Central Time)

Location: Oklahoma

Job Description

Summit Specialty Care is seeking an experienced, highly organized, and detail-oriented Oncology Prior Authorization Specialist to join our growing healthcare team.

The ideal candidate will have a strong background in oncology prior authorizations, insurance verification, specialty medications, chemotherapy, immunotherapy, and medical necessity requirements.

This position plays a critical role in ensuring patients receive timely access to cancer treatments while maintaining accurate authorizations, minimizing insurance denials, and supporting efficient revenue cycle operations.

Key Responsibilities

Oncology Prior Authorizations

• Obtain and manage prior authorizations for chemotherapy, immunotherapy, biologics, injections, infusion therapies, and other oncology-related services.
• Submit authorization requests through insurance portals, electronic systems, and direct payer communication.
• Verify authorization requirements for medications, administration codes, treatment plans, and procedures.
• Ensure authorizations accurately reflect HCPCS/J-codes, CPT codes, diagnosis codes, medication dosages, units, frequency, and approved treatment dates.
• Monitor pending authorizations and follow up with insurance companies until a determination is received.
• Track authorization expiration dates, approved units, and treatment cycles to prevent interruptions in patient care.

Insurance Verification and Medical Necessity

• Verify insurance eligibility, benefits, coverage limitations, and payer-specific authorization requirements.
• Review medical records, physician orders, pathology reports, clinical notes, and treatment plans to ensure all necessary documentation is available.
• Identify payer medical necessity requirements and assist with obtaining additional documentation when needed.
• Coordinate with clinical staff and providers to resolve missing or incomplete information.

Denials, Appeals, and Follow-Up

• Investigate denied or delayed authorizations and determine appropriate corrective actions.
• Prepare and submit authorization reconsiderations and appeals with supporting clinical documentation.
• Coordinate peer-to-peer reviews between providers and insurance medical directors.
• Maintain accurate documentation of payer communications, reference numbers, authorization decisions, and follow-up activity.

Department Coordination and Reporting

• Communicate authorization status to scheduling, nursing, pharmacy, billing, and management teams.
• Ensure patients are properly cleared before treatment is scheduled or administered.
• Maintain accurate authorization tracking reports and provide regular updates on pending, approved, and denied