Insurance Authorization Specialist III

This is a fully remote position, open to applicants in Virginia, +1 more state.

📋 Description

• Secure authorizations for elective infusions and injections to financially clear patients and ensure reimbursement.

• Utilize payor resources and medical policies to confirm prior authorization requirements.

• Identify financial clearance risks and escalate them in accordance with the Financial Clearance Program.

• Serve as a liaison between clinical teams and pharmacists regarding issues related to infusion prior authorization.

• Code cases and assess clinical documentation for completeness and optimal reimbursement.

• Prioritize workloads and meet deadlines using EPIC work queues.

• Gather and relay outpatient benefit information to Patient Financial Services through Epic queues and billing indicators.

• Consult medical and coverage policies for medications and investigate CPT codes for drugs/injections.

• Validate and submit authorizations via insurance portals, forms, or phone calls.

• Review medical records to address clinical authorization inquiries.

• Communicate with clinics when additional information is required.

• Follow up on authorization requests, peer-to-peer reviews, and prior authorization appeals.

• Notify when home infusion or pharmacy benefits are necessary.

• Confirm referrals and authorizations in work queues and identify changes in medication dosing/frequency.

• Assist with denial management and secure retro authorizations.

• Maintain Epic in baskets and Outlook emails.

• Engage in monthly team meetings and one-on-ones.

• Establish admissions and submit authorizations for elective inpatient chemotherapy admissions and observations.

• Adhere to workflows, report process deficiencies, uphold confidentiality, and communicate respectfully with staff, physicians, patients, families, and the public.

⛳️ Requirements

• High school diploma or equivalent with 2 years of experience in a medical setting, or 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 (preferred).

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

• Proficient in Microsoft Office Suite.

• Strong communication and interpersonal skills.

• Capability to prioritize tasks to meet deadlines and manage a large workload with efficiency and attention to detail.

• Basic computer proficiency.

• Minimum typing speed of 25 words per minute.

• Strong reading and comprehension skills.

• Ability to work in an outpatient clinical setting.

• Must be eligible to work in the United States of America.

🏝️ Benefits

• Competitive salary and benefits package.

• Opportunities for professional development and growth.

• Supportive team environment.