Authorization Specialist

KabaFusion

Cerritos (CA)

On-site

USD 70,000 - 95,000

Full time

7 days ago

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Benefits offered by this job

Competitive compensation

Benefits start on day one

401k with 4% match

PTO / Holidays

Life insurance

Employee assistance program

Learning & Development

Employee discounts

Referral program

Job summary

KabaFusion is seeking a skilled healthcare authorization specialist to manage complex eligibility, authorization, and financial assistance cases for home infusion services. The role focuses on escalations, second-level appeals, complex reimbursement issues, and removing payer barriers to patient access while ensuring compliance with payer requirements.

You will work with intake, clinical, pharmacy, and billing teams to ensure timely patient onboarding, accurate documentation, and adherence to

Qualifications

High school diploma or equivalent required.
Associate or bachelor’s degree in health care or related field preferred.

Responsibilities

Manage escalated authorization cases with complex payer requirements.
Lead second-level appeals with detailed documentation and payer communication.
Troubleshoot Revenue Cycle Management issues related to authorization, denials, and reimbursement barriers.
Manage challenging copayment assistance cases with foundations, manufacturers, and internal teams.
Identify retraining needs and support intake training teams.
Assist with intake, eligibility, and authorization workflows as needed.
Serve as subject matter expert on authorization workflows and payer policies.
Collaborate with intake, clinical, pharmacy, and billing teams for seamless patient onboarding.
Identify risks to authorization approval or reimbursement and implement mitigation strategies.
Assist with SOPs, policies, and training materials.
Maintain accurate documentation for compliance and audit readiness.
Identify trends in denials and recommend process improvements.
Support projects requiring authorization, copay assistance, or eligibility expertise.

Skills

Prior authorization

Payer guidelines

RCM processes

Attention to detail

Communication skills

Independent work

Problem solving

Education

High school diploma or equivalent

Associate or bachelor’s degree in health care

Tools

CPR+ software

Microsoft Office

Job description

Come join an exciting and innovative company that puts the “care” back in healthcare!

At KabaFusion, our patients come from all walks of life and so do we. We hire GREAT people, period! Our culture celebrates and supports the differences that make us unique. Here, it doesn’t matter what your role is, your hard work and dedication is not only recognized but celebrated. Join us and find out why this is the place to excel and do your best work.

About Us:

What started as a single pharmacy in 2010 has grown into KabaFusion becoming the largest privately held home infusion company in the country. We have a national network of pharmacies and nursing offices strategically placed to service 40+ states. Couple that with over 30 years of combined experience and it’s no wonder why KabaFusion is the industry leader in home infusion.

JOB SUMMARY:

This position is responsible for managing complex and high-risk eligibility, authorization, and financial assistance cases within home infusion services. This role specializes in escalations, second-level appeals, complex reimbursement issues, and challenging copayment assistance scenarios. In addition, this position plays a key role in removing payer and financial barriers to care, ensuring timely patient access to therapy while maintaining compliance with payer requirements and organizational standards.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Manage escalated authorization cases involving complex payer requirements and non-standard scenarios.
Lead second-level appeals, including preparing detailed documentation, clinical justification, and payer communication.
Troubleshoot and resolve complex Revenue Cycle Management related issues tied to authorization, denials, and reimbursement barriers.
Manage challenging copayment assistance cases, including coordination with foundations, manufacturers, and internal teams.
Identify potential areas for retraining and support management and intake training team to implement a training plan.
Assist with covering intake, eligibility, and authorization workflows as needed.
Serve as the subject matter expert on authorization workflows, payer policies, and escalation pathways.
Work closely with intake, clinical, pharmacy, and billing teams to ensure seamless patient onboarding and continuity of care.
Proactively identify risks to authorization approval or reimbursement and implement mitigation strategies.
Assist with writing standard operating procedures, policies, information tools, and training tools.
Maintain accurate, thorough documentation in all systems to ensure compliance and audit readiness.
Identify trends in denials or escalation cases and recommend process improvements.
Assist with any projects that require authorization, copay assistance, demographic entry, or eligibility expertise.
Other related duties as assigned by manager or designee.

JOB REQUIREMENTS AND QUALIFICATIONS

Education:

High school diploma or equivalent required.
Associate or bachelor’s degree in health care of related field preferred.

Experience

Minimum three (3) years of experience in healthcare authorizations, insurance verification, reimbursement, or revenue cycle operations, preferably in home infusion, specialty pharmacy, or a related healthcare setting.
Experience managing prior authorizations, second-level appeals, and payer requirements for specialty therapies, infusion services, and high-cost medications.
Knowledge of commercial, Medicare, and Medicaid payer guidelines, authorization processes, and reimbursement requirements.
Working knowledge of HCPCS, CPT, and other applicable coding systems related to infusion and specialty pharmacy services.
Experience obtaining authorizations and reimbursement for specialty, biologic, and high-cost medications.
Understanding of revenue cycle management (RCM) processes and the impact of authorizations on reimbursement and claims outcomes.
Experience navigating copay assistance, patient assistance, and other financial support programs for specialty therapy patients.
Proficient experience with Microsoft Office including Word, Excel, PowerPoint, Outlook, Teams, and CPR+ software system or similar system preferred.

Skills and Competencies:

Strong knowledge of prior authorization processes, payer guidelines, and coverage requirements across commercial, Medicare, and Medicaid plans.
Ability to interpret insurance benefits, medical necessity criteria, coverage determinations, and complex payer policies to support successful authorization and appeal outcomes.
Proven ability to manage complex or escalated authorization cases, including denials, appeals, and difficult approvals.
Understanding of revenue cycle management (RCM) processes and the impact of authorizations on reimbursement and financial outcomes.
Strong critical thinking, analytical, and problem-solving skills with the ability to identify barriers and develop effective solutions.
Excellent verbal and written communication skills, including the ability to communicate effectively in highpressure or sensitive situations.
Demonstrated ability to work independently, prioritize competing demands, and manage multiple cases simultaneously while maintaining accuracy and timeliness.
Strong attention to detail and commitment to quality, compliance, and patient-centered service.

What we offer: