Benefits and Authorizations Specialist Lead

Nira Medical Group; United States; Remote; USD 60,000 - 82,000; Full time

Job summary

Nira Medical Group is seeking a Benefits and Authorizations Specialist Lead to verify insurance coverage, manage pre-authorizations, and coordinate financial assistance for medical and infusion services in a remote, full-time capacity in the United States.

You will lead the team, verify eligibility, obtain authorizations, assist with denials, stay current with payer rules, and communicate patient financial responsibilities, while helping patients access programs.

Qualifications

• High school diploma or equivalent (required).
• 2–3 years of experience in medical insurance verification and prior authorizations (infusion services preferred).
• Knowledge of insurance terminology, plan types, structures, and approval types.
• Experience with J-codes, CPT and ICD-10 coding; Athena experience is a plus.
• Strong organizational skills, detail orientation, and ability to multitask in a fast-paced setting.

Responsibilities

• Verify and document insurance eligibility, benefits, and coverage for all office visits and infusion services.
• Obtain insurance authorization and pre-certification for visits and infusion services.
• Facilitate insurance denial mitigation steps such as peer-to-peer reviews and appeals.
• Maintain knowledge of infusion drug authorization requirements for payers and regulatory guidelines.
• Calculate and communicate patient financial responsibility; provide financial assistance information to patients.

Skills

Insurance verification

Pre-authorizations

Financial assistance

Team leadership

Organizational skills

Attention to detail

Communication

Education

High school diploma or equivalent

Tools

Athena

Job description

Benefits and Authorizations Specialist Lead

Remote Full-time

Daily Drop — Subscriber Perk

Professional online therapy

Lead the team, take care of yourself. 50% off your first therapy month.

Job Summary: The Benefits Specialist Lead is responsible for verifying patient insurance coverage, submitting pre-authorizations, and financial assistance support to ensure patients receive coverage for medical and infusion services provided.

Key Responsibilities:

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

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

• Facilitate insurance denial mitigation steps such as peer-to-peer reviews and appeals.

• Maintains a good working knowledge of infusion drug authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization.

• Calculate and communicate patient financial responsibility.

• Provide financial assistance support to patients including identifying patient assistance programs and manufacturer copay assistance enrollment.

Qualifications:

• High school diploma or equivalent

• 2-3 years of experience in medical insurance verification and prior authorizations. Experience in infusion services is preferred.

• · Knowledge of insurance terminology, plan types, structures, and approval types

• · Previous experience with J-codes, CPT and ICD-10 coding

• Previous Athena use a plus, but not a requirement

• · Knowledge of medical terminology and clinical documentation review

• Strong organizational skills

• Detail-oriented

• Ability to multi-task and work well in a fast-paced setting

• Critical thinking skills and decisive judgment

We like the way you work it · no gig iddy · Gotta bag it up · no gig iddy ·

We like the way you work it · no gig iddy · Gotta bag it up · no gig iddy ·