Prior Authorization Representative at RPCI Oncology PC – Williamsville, New York

We are seeking a Prior Authorization Representative to join our GROWING team!

Roswell Park Care Network is a recognized leader in oncology and specialty care, supporting community physician practices across New York State. We are committed to delivering exceptional patient care while advancing innovative treatment options in a collaborative and patient-focused environment.

Comprehensive Benefits:

• Monday-Friday schedule
• Medical, dental, and vision coverage
• Employer funded Health Reimbursement Account (HRA)
• 401(k) with company match
• Generous vacation and sick time
• Company-paid life insurance
• 11 paid Holidays

As the Prior Authorization Representative you will be responsible for providing accurate and complete data for precertification requests, oral medications, and procedures, while delivering excellent customer service.

The Prior Authorization Representative position offers a hybrid schedule. After successfully completing on-site training, the schedule transitions to one on-site day per week!

Responsibilities:

• Answers calls from physician offices and patients using exemplary customer service skills
• Obtain insurance verification, authorizations/pre-certifications
• Scheduling of diagnostic imaging, injections, surgical procedures
• Accurately enter required information (non-clinical and structured clinical data) into computer databases
• Reviews structured data matched it against specified medical terms and diagnoses or procedure codes and follow established procedures for authorizing request or referring request for further review
• Call back providers with precertification numbers as needed and file completed precertification requests as per established procedures
• Follow-up for discharge dates as needed
• Print and send form letters correspondence as needed
• Maintain patient confidentiality as defined by state, federal and hospital regulations

Education/Experience:

• High School diploma or G.E.D. and the equivalent of six (6) months of full-time RPCI Oncology, PC clinical OR Administrative health care experience
• Must have prior customer service experience in an office preferably with patients
• Must have experience working in Windows and with MS Office software