Handles timely submission, follow-up, documentation, and approval of patient prior authorizations. Reviews supporting information, assists with medical necessity documentation and appeals, communicates with insurers and stakeholders, records authorization details, monitors expiring approvals, and supports patient care operations while complying with organizational and legal standards.
Prior Authorization Specialist
Job Description
Infusion for Health is a referral-based infusion center that services all providers in multiple locations in California, Arizona, Nevada, Washington, Colorado, and Missouri. Our center is unique and offers individual comfortable private rooms for our patients. Our mission is to provide exceptional service in the administration of infusion therapy in a comfortable, patient-focused environment by providing exemplary professional clinical care.
Our company is continuing to grow and we're looking to add a Prior Authorization Specialist to support our patient care operations department.
This is a full-time, 5 days a week position, onsite at our Brea HQ office.
Compensation: $23-$27/hr DOE + Benefits
Key Responsibilities:
- Responsible for ensuring timely, accurate submission follow-up and approval of Authorizations. Work with urgency, high-quality and high communication with patients, insurance and additional stakeholders as needed.
- Review the accuracy and completeness of the information requested and ensure that all supporting documents are present
- Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
- Collaborate with other departments to assist in obtaining prior authorizations/appeals
- Document all interactions with insurance companies or other stakeholders within the company system
- Document all prior authorization information, including approval dates, billing units, procedure codes, and prior authorization number in the patient profile
- Proactively work on prior authorizations that are due to be expired
- Conduct job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards
- Completes all required duties, projects, and reports in a timely fashion on a daily, weekly, or monthly basis per the direction of the leadership.
- Other duties as assigned
Education and/or Experience Needed:
- At least 2 years experience in infusion or pharmacy prior authorization is required
- At least 2 years of experience applying knowledge of Medicare, Medicaid, and Managed Care reimbursement guidelines
- Ability to effectively handle multiple priorities within a changing environment, emphasizing paperless workflow
- Experience in diagnosing, isolating, and resolving complex issues and recommending and implementing strategies to resolve problems.
- Intermediate level skills in Microsoft Excel & Word
Monday to Friday
40
Infusion for Health Brea, California, USA Office
135 S State College Blvd, Brea, California, United States, 92821 5814
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