At Oregon Specialty Group, we take care of people.  The Prior Authorization department and other clinical operations functions are crucial to this mission because they expedite the behind-the-scenes processes that get our patients quickly to the next appropriate step in their care.

The Prior Authorization Specialist is key to department success because their expertise in arranging timely and accurate referrals and obtaining pre-authorizations from insurance companies allows our patients to quickly access the important treatment they need.

Essential Job Functions

• Receives and processes prior authorizations required for treatment.
• Obtains insurance pre-authorization for patients and re-authorization of additional treatment.
• Ensures insurance carrier documentation requirements are met.
• Efficiently manages correspondence with the clinical team and insurance carriers.
• Works in collaboration with the entire revenue cycle team to improve processes and prevent financial toxicity for our patients.
• Ensures NCCN guidelines are followed and seeks clarification when through the pre-authorization process an order is found to not be in alignment.
• Maintains appropriate reports to accommodate transitioning patient and payer needs.

Required Qualifications

• 2 years Prior Authorization or Medical Billing experience
• Medical terminology
• Highschool diploma or GED certificate
• Basic computer skills, EMR data entry experience
• Attention to detail

Preferred Qualifications

• Associates Degree
• Oncology/Hematology/Rheumatology Prior Authorization or Medical Billing experience

A successful Prior Authorization Specialist will….

• Enjoy helping people get the care they need
• Balance efficiency with exceptional communication skills
• Develop great time management boundaries
• Create and maintain efficient process
• Possess strong attention to detail
• Maintain a positive attitude
• Understand that their work truly impacts patient outcomes