Benefits and Authorizations Specialist, Lead

This is a fully remote position, open to applicants in United States.

📋 Description

• Verify and document the eligibility of insurance, benefits, and coverage for all office visits and infusion services.

• Secure insurance authorization and pre-certification for office visits and infusion services.

• Assist in mitigating insurance denials through peer-to-peer reviews and appeals.

• Maintain a thorough understanding of authorization requirements for infusion drugs across all payers, along with state and federal regulatory guidelines for coverage and authorization.

• Calculate and communicate the financial responsibilities of patients.

• Offer financial assistance support to patients by identifying patient assistance programs and facilitating manufacturer copay assistance enrollment.

⛳️ Requirements

• High school diploma or its equivalent.

• 2-3 years of experience in medical insurance verification and prior authorizations, with a preference for experience in infusion services.

• Familiarity with insurance terminology, plan types, structures, and approval processes.

• Prior experience with J-codes, CPT, and ICD-10 coding.

• Previous use of Athena is advantageous but not mandatory.

• Understanding of medical terminology and clinical documentation review.

• Strong organizational skills.

• Detail-oriented approach.

• Ability to manage multiple tasks and thrive in a fast-paced environment.

• Critical thinking abilities and decisive judgment.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Flexible work environment with remote opportunities.

• Professional development and growth opportunities.

• Supportive team culture focused on collaboration and innovation.