Senior Precertification Specialist

Company : Columbus Oncology & Hematology

Job Description - Senior Precertification Specialist

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.
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.

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Senior Precertification Specialist

Job Description - Senior Precertification Specialist

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