Open Opportunities

The Prior Authorization Specialist I supports Oregon Specialty Group’s operational and financial performance by obtaining insurance authorizations for services across multiple specialties, verifying payer requirements, and maintaining accurate authorization-related information in the appropriate systems. This role helps ensure services are supported by current payer approval and required clinical documentation prior to treatment, reducing avoidable delays and reimbursement risk. The position contributes to departmental goals by promoting accuracy, timeliness, compliance, and effective coordination across clinical and revenue cycle functions.

Essential Job Functions
• Performs prior authorization functions accurately and consistently to support patient access, reimbursement readiness, and operational efficiency.
• Demonstrates working knowledge of payer authorization requirements, documentation standards, specialty service approvals, and workflow expectations while adhering to established procedures, compliance requirements, and service standards.

Workflow Operations
• Obtains insurance authorizations for all specialties including chemotherapy, immunotherapy, biologics, specialty infusions, advanced imaging, laboratory testing, and genetic testing.
• Determines payer specific authorization criteria for Medicare, Medicaid, and commercial insurance plans.
• Ensures that insurance carrier documentation requirements are met. Collaborating with clinical staff to obtain additional information when necessary.
• Monitors authorization status and follow up proactively with payers.
• Escalates when an order is found to not be in alignment for NCCN guidelines are followed and seek clarification.
• Manages high-volume authorization workloads with strict turnaround times.
• Prioritizes urgent STAT requests based on clinical urgency.

Documentation and Business System/EHR
• Accurately enters authorization data and related updates into the EHR and other designated systems. 
• Maintains clear, timely, and complete documentation of authorization activity, payer communication, status updates, and next steps. 
• Utilizes reports and tracking tools to support changing patient and payer needs. 
• Maintains data integrity and supports continuity of work through complete and accurate system documentation.

Communication
• Provides clear and professional information to clinical staff, payers, and internal team members regarding authorization requirements, status updates, and coverage limitations.
• Collaborate with the Prior Authorization team to support workflow consistency and process improvement.
• Escalates payer limitations or barriers that may affect treatment planning through appropriate channels. 
• Provides responsive, service-oriented support while maintaining professionalism and discretion.

Autonomy
• Works independently on routine authorizations within established guidelines. 
• Seeks guidance for complex, non-standard, or escalated cases. 
• Follows defined workflows with limited decision-making authority. 
• Prioritizes daily workload, including urgent requests, with oversight as needed. 
• Collaborates with team members but relies on leadership for exceptions and appeals.

Complexity Band
• Handles high-volume, multi-specialty authorizations with defined processes and payer guidelines. 
• Applies established criteria (Medicare, Medicaid, commercial) with limited interpretation or escalation for exceptions. 
• Coordinates across clinical and revenue cycle teams to gather documentation and resolve routine issues.
• Balances competing priorities, including urgent STAT requests, within strict turnaround times. 
• Ensures accuracy in EHR data entry, tracking, and reporting with attention to compliance standards. 
• Identifies and communicates coverage limitations, escalating complex or non-aligned cases as needed.

Reliability 
• Regular, predictable, and reliable attendance is required to perform the essential duties of this position and to meet operational deadlines, maintain team coverage, and complete time-sensitive work that depends on in-person coordination and access to on-site systems/resources. Employees must report to work as scheduled, be punctual, and remain at work for assigned hours. For roles requiring coordination with patients, providers, and/or teams, consistent availability during scheduled hours is necessary to maintain safe and effective operations, continuity of work, and timely completion of job responsibilities. Employees must follow established call-out and scheduling procedures and provide timely notice of unscheduled absences when feasible. OSG will comply with applicable federal and Oregon laws regarding protected leave and reasonable accommodations. 
• Performs other related duties as assigned by management, for which appropriate training will be provided, to support departmental objectives and organizational success.

Required Qualifications
• High school diploma or GED required. 
• Minimum one year of prior authorization, medical billing, or related healthcare revenue cycle experience required. 
• Knowledge of medical terminology required. 
• Basic computer skills and EHR data entry experience required. 
• Strong attention to detail and ability to manage multiple priorities accurately and efficiently.

Preferred Qualifications
• Associate degree preferred. 
• Experience in oncology, hematology, rheumatology, or other specialty prior authorization or medical billing environments preferred.

A successful Prior Authorization Specialist I will….
• Help patients access needed care through timely and accurate authorization support. 
• Communicate clearly while maintaining efficiency and professionalism. 
• Manage time effectively and prioritize routine and urgent work appropriately. 
• Build and maintain organized, efficient workflows. 
• Demonstrate strong attention to detail and accountability in documentation and follow-up. 
• Maintain a positive, solutions-focused approach and understand the impact of timely authorizations on patient care.