Job Description

Columbus Oncology and Hematology Associates is currently searching for a talented individual to join our prior authorization team located in Dublin. Our mission is to improve the lives of those with cancer and blood disorders. We provide a wonderful work environment and corporate culture. In addition, we pride ourselves on offering a comprehensive benefits package, competitive pay, and we value work-life balance for our staff members.

The Senior  Precertification Specialist will complete the duties of the Precertification Specialists, as well as the following...

• Advanced Case Management: Analyze complex prior authorization cases, proactively identifying potential coverage challenges and working with payers to secure timely approvals.
• Leadership & Mentorship: Serve as a resource for junior team members, providing guidance on payer policies, medical necessity reviews, and best practices. Assist in training new employees.
• Process Optimization: Identify inefficiencies in prior authorization workflows and collaborate with leadership to implement process improvements that support faster authorizations and reduce denials.
• Interdepartmental Collaboration: Act as a liaison between the precertification team, clinical staff, billing department, and scheduling teams, ensuring smooth communication and coordination for authorization-related matters.
• Compliance & Policy Adherence: Maintain up-to-date knowledge of payer policies, Medicare guidelines, and NCCN protocols. Provide recommendations on adjustments to internal procedures to maintain compliance.
• Escalation & Resolution: Handle escalated cases requiring appeals, medical director reviews, and direct payer negotiations for high-priority authorization requests.

Qualifications:

• 3–5 years' experience in a physician practice or healthcare setting performing prior authorization activities, with oncology experience preferred, specifically oncology nursing. 
• Extensive knowledge of health insurance regulations, including payer-specific authorization policies.
• Proficiency in ICD-10 and CPT coding, with demonstrated expertise in oncology-related coding and medical necessity review.
• Advanced proficiency in EMR systems, practice management software, and Microsoft Office applications (Outlook, Word, Excel).
• High school diploma or GED required; additional certification in medical billing, coding, or healthcare administration preferred.

Columbus Oncology Associates is an Equal Opportunity Employer and proudly a Drug-Free Workplace.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. 

Job Tags

Full time,

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