The posting
Medical Oncology Associates of San Diego is a proud partner of One Oncology's network of the nations leading oncology practices.
Why Join Us? We are looking for talented and highly-motivated individuals who demonstrate a natural desire to support the meaningful work of community oncologists and the patients we serve.
Job Description:
The Authorization & Referral Specialist is responsible for obtaining, managing, and documenting insurance authorizations and referral approvals for services provided both within MOASD and by outside healthcare providers and facilities. This position serves as a liaison between payers, providers, patients, and healthcare organizations to coordinate approval processes and support timely delivery of care.
Patient-Centered Care MOASD is committed to delivering compassionate, coordinated, and patient-centered care. The Authorization & Referral Specialist supports this mission by proactively removing insurance-related barriers to treatment and referral services, coordinating approvals across multiple healthcare organizations, and advocating for timely access to medically necessary care. This role helps minimize treatment delays and supports continuity of care throughout the patient journey.
Key Areas of Responsibility:
Treatment Authorization Management • Obtain and manage authorizations for infusion therapies, injectable medications, and other in-office treatments. • Review assigned work queues, schedules, and provider orders to identify authorization requirements. • Submit complete and accurate authorization requests to payers. • Monitor authorization status and ensure approvals are secured prior to scheduled treatment whenever possible. • Coordinate peer-to-peer reviews and additional documentation requests when required by payers. • Communicate authorization outcomes, delays, denials, and approval information to providers, nursing staff, schedulers, and Financial Counselors. • Escalate authorization barriers that may impact patient care according to department procedures. • Assist with appeals and reconsiderations when appropriate. • Maintain accurate authorization documentation within the electronic medical record. • Ensure authorizations are obtained within established departmental timelines. • Prioritize urgent and same-day patient care needs appropriately.
Referral and Outside Service Management • Obtain authorizations for office visits, referrals, imaging, diagnostic testing, procedures, and other services performed outside of MOASD. • Verify payer requirements and referral pathways. • Coordinate with referring providers, outside facilities, and payer representatives to secure approvals. • Ensure all required clinical documentation is submitted to support authorization requests. • Monitor pending requests and follow up proactively to prevent delays in patient care. • Document authorization activity and outcomes in accordance with department standards. • Communicate authorization status to patients and internal teams as appropriate.
Patient Coordination and Communication • Serve as a resource for patients regarding authorization requirements and payer processes. • Communicate professionally and compassionately with patients experiencing treatment or referral delays. • Support patient access by identifying and escalating barriers to care. Interdepartmental Collaboration • Collaborate with providers, nursing, scheduling, financial counseling, revenue cycle, and management teams to facilitate timely patient care. • Respond to authorization-related inquiries within established departmental timelines. • Participate in process improvement initiatives designed to improve authorization efficiency and reduce treatment delays. • Promote positive working relationships across departments and external organizations.
Documentation and Compliance • Maintain accurate, timely, and complete documentation within OncoEMR and other applicable systems. • Ensure all authorization records, payer communications, and supporting documentation are appropriately filed. • Maintain compliance with HIPAA, payer regulations, and organizational policies. • Identify trends, denials, and workflow concerns and communicate findings to leadership.
*This job description is not designed to cover an exhaustive list of duties. Other duties may be assigned and activities may change any time with or without notice, as applicable. Furthermore, job descriptions do not establish a contract or change the at-will nature of employment.
Experience, Qualifications, Education • Minimum three years of healthcare authorization, referral coordination, or related revenue cycle experience required. • Experience obtaining both treatment and referral authorizations preferred. • Working knowledge of managed care, IPA, HMO, PPO, and Medicare authorization requirements. • Knowledge of CPT, HCPCS, ICD-10, and medical necessity documentation requirements. • Oncology, infusion, specialty practice, or high-acuity healthcare experience preferred. • High school diploma or GED required. Associate degree, vocational training, or additional healthcare-related education preferred.
Knowledge, Skills, and Abilities • Strong understanding of insurance authorization processes. • Ability to interpret payer policies and authorization requirements. • Excellent organizational and time-management skills. • Strong attention to detail and accuracy. • Ability to manage multiple priorities in a fast-paced environment. • Effective verbal and written communication skills. • Strong problem-solving and critical-thinking abilities. • Ability to work independently while collaborating effectively with cross-functional teams. • Commitment to professionalism, confidentiality, and customer service. • Proficiency with electronic medical records and standard business software applications. • Visual acuity to read a computer screen and paper documents; close and distance vision, peripheral vision depth perception, ability to adjust focus. • Hearing acuity to converse with staff and customers in person and by phone. • Ability to stoop, bend, kneel, reach with hands, and lift and move 10 pounds on a regular basis, and up to 25 pounds occasionally; ability to sit for hours at a time.
Working Conditions: This position functions indoors in a medical/business environment. Employee will be exposed to moderate noise levels and interruptions. Visual acuity to read and compute screen and paper documents; close and distance vision, peripheral vision depth perception, ability to adjust focus; hearing acuity to converse with staff and customers. Ability to sit for hours at a time. Employee will be exposed to moderate noise levels and interruptions.
Travel: Travel between local offices when necessary.
Pay:
$24-$32
