The US Oncology Network

Supports independent oncology practices, patient care

Precertification Specialist

Clinical Support & Patient AdministrationConfirmed live in the last 24 hours

Full-timeTeaneck, NJ, USA$18.99 - $29.22 /hrRemote

About the Job

Requirements

A high school diploma or equivalent is required.
At least two years of experience in a patient access or financial clearance role is required.
Advanced knowledge of medical terminology is required.
Ability to navigate different systems and multitask efficiently is required.
Successful completion of required e-learning courses within 90 days of starting the position is required.
Maintain current knowledge of healthcare reimbursement, insurance authorization requirements, industry standards, and applicable regulations.
Apply technical knowledge and established processes to complete prior authorization activities accurately and promptly.
Effectively use available tools, systems, and resources to support operational goals and patient needs.
Manage multiple priorities while maintaining accuracy and attention to detail.
Build and maintain positive working relationships with patients, physicians, coworkers, supervisors, insurance carriers, and other external partners.
Communicate professionally, respectfully, and effectively to support patient experiences and team collaboration.
Exercise sound judgment when evaluating information, resolving issues, and determining appropriate courses of action.
Make timely, accurate, and cost-effective decisions while ensuring compliance with organizational policies and payer requirements.
Make informed decisions in situations involving uncertainty or limited information.
Take ownership of responsibilities and follow through on commitments.
Maintain high standards of performance and professionalism and work efficiently to meet productivity, quality, and service expectations.
Deliver high-quality work focused on accuracy and compliance, support quality standards, and identify opportunities to improve workflows and operational effectiveness.
Meet the physical demands of the role, including regularly sitting and using a keyboard and mouse, and occasionally standing, walking, reaching, and lifting or moving up to 30 pounds; vision and hearing must be corrected to normal ranges.
Work in a clinic environment with frequent staff contact and regular direct patient contact, with potential exposure to blood, toxic substances, ionizing radiation, and other clinic conditions.

Responsibilities

Obtain prior authorizations promptly and keep them current to facilitate uninterrupted patient care.
Review and confirm patient insurance eligibility, benefits, and coverage for specific services in alignment with payer requirements.
Follow standard operating procedures and established guidelines to complete prior authorization tasks compliantly and accurately.
Follow up with insurance carriers on pending or denied authorizations and submit appeals when necessary.
Resolve issues or discrepancies related to prior authorization requests.
Support and adhere to the US Oncology Compliance Program, including its Code of Ethics, Business Standards, and Shared Values.
Monitor assigned worklists and emails, provide front-end authorization review, and answer authorization-related questions.
Contact patients to discuss out-of-pocket costs, offer assistance options when available, and coordinate outreach for patient plan initiation when applicable.
Review weekly denial reports and resolve issues, including submitting retroactive authorization requests or front-end appeals.
Follow workflow and promptly escalate issues to a supervisor.
Comply with confidentiality requirements and state and federal laws and HIPAA guidelines regarding patient records.
Perform other duties as requested or assigned.

Desired Qualifications

Oncology experience is preferred.

Overview

Join RCCA and make a meaningful impact on the patient journey. As a fully remote Precertification Specialist, you will be responsible for obtaining and managing prior authorizations to ensure patients receive timely access to the care and treatment they need. This role requires strong attention to detail, problem-solving skills, and a commitment to delivering exceptional service while navigating complex insurance requirements.

Employment Type: Full Time

Location: Teaneck, NJ (Remote)

Compensation: $18.99 - $29.22 hour

Compensation packages based on your unique skills, experience, and qualifications

As of the date of this posting, RCCA offers a comprehensive benefits package for this position, subject to eligibility requirements. In addition to the salary, we provide: Health, dental, and vision plans, Wellness program, Health savings account - Flexible spending accounts, 401(k) retirement plan, Life insurance, Short-term disability insurance, Long-term disability insurance, Employee Assistance Program (EAP), Paid Time Off (PTO) and holiday pay, Tuition discounts with numerous universities.

We believe these benefits underscore our commitment to the well-being and professional growth of our employees.

Responsibilities

Under general supervision, the Precertification Specialist is responsible for ensuring that prior authorizations are obtained in a timely manner and remain current, facilitating uninterrupted patient care.
Reviews and confirms patient insurance eligibility, benefits, and coverage for specific services, ensuring alignment with payer requirements
Follows standard operating procedures and established guidelines to complete tasks related to prior authorization, ensuring that all insurance requirements are met in a compliant and accurate manner
Proactively follows up with insurance carriers on pending or denied authorizations, submitting appeals when necessary
Resolves any issues or discrepancies related to prior authorization requests
Supports and adheres to the US Oncology Compliance Program, including the Code of Ethics and Business Standards and US Oncology's Shared Values.
Monitors assigned worklists and emails to provide front-end review for authorization and to answer any questions related to authorizations.
Contacts patients to discuss OOP cost,offer assistance options (if available), and coordinate outreach for patient plan initiation (if applicable).
Reviews weekly denialreport and resolves issues, including submitting retro authorization requests or front-end appeals.
Adheres to workflow and, if issues arise, escalates to Supervisor promptly.
Adheres to confidentiality and all state, federal, and HIPAA laws and guidelinesregarding patient records.
Performs other duties as requested or assigned.

Qualifications

High School diploma or equivalent required
Minimum two (2) years of experience in a patient access or financial clearance role. Oncology preferred.
Demonstrate advanced knowledge of medical terminology
Ability to navigate different systems seamlessly and able to multitask efficiently.
Must successfully complete required e-learning courses within 90 days of occupying position

COMPETENCIES

Technical and Functional Expertise

Maintains current knowledge of healthcare reimbursement, insurance authorization requirements, industry standards, and applicable regulations.
Applies technical knowledge and established processes to ensure accurate and timely completion of prior authorization activities.
Effectively utilizes available tools, systems, and resources to support operational goals and patient needs.

Adaptability and Resilience

Demonstrates flexibility and adaptability in a fast-paced healthcare environment.
Effectively manages multiple priorities while maintaining accuracy and attention to detail.
Responds positively to changing business needs, shifting priorities, ambiguity, and organizational change.
Maintains composure and productivity when faced with challenges, setbacks, or competing demands.

Customer Service Excellence

Builds and maintains positive working relationships with patients, physicians, coworkers, supervisors, insurance carriers, and other external partners.
Communicates professionally, respectfully, and effectively to support positive patient experiences and successful team collaboration.
Demonstrates a service-oriented approach that promotes patient satisfaction and operational excellence.

Judgment and Decision-Making

Exercises sound judgment when evaluating information, resolving issues, and determining appropriate courses of action.
Makes timely, accurate, and cost-effective decisions while ensuring compliance with organizational policies and payer requirements.
Demonstrates the ability to make informed decisions in situations involving uncertainty or limited information.

Accountability and Work Commitment

Takes ownership of responsibilities and follows through on commitments.
Establishes and maintains high standards of performance and professionalism.
Demonstrates initiative and a strong commitment to achieving individual and departmental goals.
Works efficiently and effectively to meet productivity, quality, and service expectations.

Quality and Continuous Improvement

Consistently delivers high-quality work and services with a focus on accuracy and compliance.
Supports and promotes quality standards across all aspects of job performance.
Identifies opportunities to improve workflows, enhance operational effectiveness, and increase efficiencies.
Contributes to continuous improvement efforts that support exceptional patient care and organizational success.

PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be offered to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit and use hands to manipulate a computer keyboard and mouse. The employee is occasionally required to stand, walk, and reach with hands and arms. The employee must occasionally lift and/or move up to 30 pounds. Requires vision and hearing corrected to normal ranges.

WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations will be offered to enable individuals with disabilities to perform the essential functions. Work is performed in an office environment. Involves frequent contact with staff. While performing the duties of this job, the employee is regularly exposed to direct contact with patients with potential for exposure to blood, toxic substances, ionizing radiation and other conditions common to a clinic environment.

About the Company

The US Oncology Network

Supports independent oncology practices, patient care

The US Oncology Network coordinates a nationwide group of independent oncology practices to deliver cancer care close to home. It provides local physicians with clinical and business support, including access to advanced technologies and shared resources, so they can offer comprehensive, value-based treatment in community settings. By pooling expertise and capabilities, the Network helps independent practices operate more efficiently and sustainably while maintaining physician autonomy. Its goal is to improve patient outcomes and physician satisfaction by delivering high-quality, patient-centered care through a scalable, practice-centric platform.

Company size: 1,001-5,000
Company stage: Not listed
Total funding: Not listed
Headquarters: Upper Merion Township, Pennsylvania
Founded: 1999

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