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.

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

• 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.

• 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.

• 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.