Outpatient CDI Infusion Specialist

Responsibilities

• Secures insurance authorizations for complex infusions therapies including oncology, chemotherapy, and biologics.
• Oversight of payer requirements and high-cost specialty medications to minimize denials and support compliant efficient workflows.
• Partners with providers, pharmacy, revenue integrity, scheduling, prior authorization, and billing teams to ensure all authorization requirements are met prior to treatment.
• Improves the accuracy of facility outpatient clinical documentation and charging by educating clinical departments and correcting root causes.
• Aids clinical areas in effectively documenting services and understanding the relationship between documentation, medical necessity, and charging for the services provided.

Requirements

• Bachelor's degree or 5+ years of related healthcare experience in lieu of degree.
• Certified Medical Assistant (CMA), Registered Medical Assistant (RMA), or relevant credentials (RN, LPN, RHIA, RHIT, CPC, COC, CDEO) required.
• Minimum of 2-4 years of prior authorization experience in oncology, infusion services, or specialty medications.
• Strong preference for experience with chemotherapy regimens, infusion scheduling, or oncology workflows.
• Experience working with Epic, preferred.

Knowledge, Skill and Ability

• Strong understanding of oncology/infusion therapies and complex medication regimens.
• Knowledge of payer authorization requirements, medical necessity criteria, and reimbursement structures.
• Familiarity with CPT, HCPCS, and ICD-10 coding.
• Ability to interpret clinical documentation and treatment plans.
• Excellent attention to detail and organizational skills.
• Strong communication and collaboration skills across clinical and non-clinical teams.
• Ability to manage multiple authorizations in a fast-paced, high-volume environment.