Cancer Care Authorization Specialist

At Urology Austin , our mission is committed to improving the lives of patients and their families through compassionate, quality, and ethical care.

In choosing a career with Urology Austin, you are choosing to improve the lives of patients and their families through a collaborative team-driven approach in an innovative, quality-driven, community-based setting. Better Medicine. Better Care.

Position Summary:
The C ancer Care Authorization Specialist is a critical member of the patient care team, specifically focused on securing access to life-saving treatments for Urology Austin’s oncology patients. This role specializes in navigating the complex prior authorization (PA) landscape for bladder cancer medications (including immunotherapy, chemotherapy, and intravesical therapies), and high-cost procedures. The primary goal is to eliminate financial and administrative barriers to care by ensuring accurate, timely insurance approvals in accordance with practice policy and payer guidelines.
JOB RELATIONSHIPS

• Reports to: Revenue Cycle Manager
• Collaborates with: Clinical Nursing Staff, Oncology Providers, Financial Counselors, and Pharmacy Technicians.

ESSENTIAL JOB RESPONSIBILITIES

• Authorization Management: Proactively manage authorizations for complex bladder cancer drug regimens (e.g., BCG, Gemcitabine, Mitomycin, and advanced immunotherapies).
• Payer Navigation: Verify patient eligibility and benefits; navigate specialized oncology medical policies to ensure clinical criteria are met for "High Risk-High Cost" medication and procedure approvals.
• Clinical Liaison: Review provider notes and pathology reports to extract necessary clinical documentation (ICD-10/CPT codes) required to justify medical necessity to insurance carriers.
• Financial Counseling Support: Update the "Insurance Verification Sheet" (IVS) with precise detail on deductibles, co-insurance, and out-of-pocket maximums; scan all approvals into the EMR (Allscripts/Urochart) to prevent claim denials.
• Appeals & Peer-to-Peer Coordination: Identify and initiate clinical appeals for denied authorizations; coordinate "Peer-to-Peer" reviews between Urology Austin physicians and insurance medical directors.
• Data Integrity: Maintain meticulous records in the EMR to track authorization expiration dates and "units" used to ensure continuous, uninterrupted treatment cycles for cancer patients.
• Cross-Functional Support: Assist with authorizations for general urology procedures (Pellets, Imaging, etc.) and perform other duties as assigned to support the Revenue Cycle team.

ROLE QUALIFICATIONS

• Education: High school diploma required; Associate or Bachelor’s degree in Healthcare Administration or related field preferred.
• Experience: Minimum 2 years of medical insurance authorization experience. Oncology or Specialty Pharmacy experience is highly preferred.
• Technical Skills: Proficiency in Allscripts or Urochart preferred. Deep understanding of CPT, HCPCS (J-codes), and ICD-10 coding specific to urology and oncology.
• Communication: Exceptional ability to communicate sensitive financial and clinical information to patients, providers, and insurance adjusters.

PERFORMANCE REQUIREMENTS Area

Expectation

Knowledge

Strong grasp of NCCN (National Comprehensive Cancer Network) guidelines or general oncology authorization workflows.

Problem Solving

Ability to research drug use policies and find pathways for approval through Patient Assistance Programs (PAPs) or foundations if insurance denies coverage.

Attention to Detail

High accuracy in calculating patient cost-shares and ensuring "units" authorized match the prescribed dosage.

Urgency

Understanding that delays in authorization can directly impact a cancer patient's clinical outcome.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

• Environment: Primarily office setting (80% sitting/computer work).
• Stress Level: High. Requires the ability to remain calm and professional while dealing with high-stakes medical timelines and tense interactions with insurance payers.
• Physical: Ability to lift up to 20 lbs; frequent use of dual-monitor computer setups and multi-line phone systems.