Job Description:Organization: Carolina Oncology Specialists
Location: Remote
Department: Revenue Cycle Management
Reports To: Director of Revenue Cycle Management
FLSA Status: Exempt
Position SummaryCarolina Oncology Specialists is seeking an experienced and strategic Pre-Certification / Authorization Manager to lead and oversee all prior authorization functions across the organization. This role is responsible for ensuring timely and accurate authorization of oncology services, optimizing approval rates, reducing denials, and maintaining compliance with payer and regulatory requirements. The Manager will supervise authorization staff, collaborate with clinical and revenue cycle leadership, and drive process improvements to support high-quality, patient-centered care and financial performance.
Key Responsibilities - Lead and manage the daily operations of the pre-certification/authorization team
- Oversee the timely submission and follow-up of prior authorizations for oncology services, including chemotherapy, infusions, radiation therapy, imaging, and specialty medications
- Establish and monitor team productivity, quality, and turnaround time metrics
- Ensure compliance with payer guidelines, CMS regulations, and organizational policies
- Develop and implement standard workflows, policies, and best practices for authorization processes
- Monitor authorization trends, denials, and payer behaviors; develop action plans to improve approval rates
- Collaborate with physicians, nursing, scheduling, coding, and billing teams to ensure seamless coordination of patient care and reimbursement
- Oversee denial management processes, including appeals and peer-to-peer review coordination
- Serve as escalation point for complex authorization cases and payer issues
- Provide coaching, training, and performance management for authorization staff
- Participate in audits and compliance reviews to ensure accuracy and regulatory adherence
- Maintain up-to-date knowledge of oncology treatment protocols, payer policy changes, and industry best practices
- Identify and implement opportunities for automation, efficiency, and process improvement
- Support budgeting, staffing, and resource planning for the authorization function
Minimum Qualifications Education & Certification - High school diploma or equivalent required
- Bachelor's degree in healthcare administration, business, or related field preferred
- Certification in healthcare access or revenue cycle (e.g., CPAR, CHAA, CRCR) preferred
Experience - Minimum of 5 years of experience in prior authorizations, insurance verification, or revenue cycle operations
- Minimum of 2 years of leadership or supervisory experience
- Oncology, infusion, or specialty practice experience strongly preferred
- Experience with EMR/EHR systems and payer portals required
Required Skills - Advanced knowledge of Medicare, Medicaid, and commercial payer authorization requirements
- Strong understanding of oncology services and treatment workflows
- Familiarity with CPT, ICD-10, and HCPCS coding concepts
- Demonstrated leadership, team management, and coaching skills
- Strong analytical and problem-solving abilities
- Excellent communication and interpersonal skills
- Ability to manage multiple priorities in a fast-paced, deadline-driven environment
- Strong organizational skills and attention to detail
