Insurance Authorization Specialist III

📋 Description

• This role is tasked with securing authorizations for elective infusions and injections to financially clear patients and guarantee reimbursement for the organization.

• Utilize payor resources and any relevant reference materials, including payor and medical policies, to confirm precise prior authorization requirements.

• Identify and escalate financial clearance risks as necessary, ensuring compliance with the Financial Clearance Program.

• Act as a liaison between clinical teams and pharmacists to facilitate effective communication regarding infusion prior authorization matters.

• Ensure cases are coded, and clinical documentation is thoroughly reviewed to confirm completeness aimed at maximizing reimbursement.

⛳️ Requirements

• High school diploma or equivalent with 2 years of experience in a medical setting (such as a hospital, physician’s office, or outpatient clinic).

• An associate’s degree with 1 year of experience in a medical environment.

• 3 years of experience with knowledge and interpretation of medical terminology, ICD-10, and CPT codes.

• Familiarity with authorization processes, insurance guidelines, and practices of third-party payors.

• Proficient in Microsoft Office applications.

• Strong communication and interpersonal skills.

• Ability to prioritize tasks to meet deadlines and manage a high volume of work efficiently with keen attention to detail.

• Basic computer skills.

🏝️ Benefits

• N/A