Infusion Insurance & Authorization Specialist

Medix Infusion; Addison (TX); On-site; USD 45,000 - 65,000; Full time

Job summary

Medix Infusion is seeking an Insurance Specialist to verify insurance eligibility and benefits for infusion services, review medical necessity guidelines, and ensure accurate documentation. You will handle authorizations, predeterminations, and appeal requests, coordinating with Intake, Scheduling, Pharmacy, and Clinical teams to keep patient care on track.

The role requires 2-3 years in healthcare or medical claims billing, familiarity with Medicare/Medicaid policies, and strong communication

Qualifications

• 2-3 years of experience in healthcare, pharmacy, or medical claims billing and coding, including prior authorization and appeals.
• Strong understanding of Medicare, Medicaid, and commercial payer policies.
• Excellent communication skills and attention to detail.

Responsibilities

• Verify insurance eligibility and benefits via phone, fax, or payer portals.
• Ensure timely completion of insurance reviews and documentation in the EMR system.
• Review payer medical policies to confirm medical necessity, including Medicare and FDA guidelines.
• Obtain necessary documentation from medical providers to support medical necessity.
• Submit and follow up on appeal requests for denied authorizations.
• Coordinate with departments to prevent delays in patient care.
• Assist in training staff and attend departmental meetings as needed.

Skills

Prior authorization

Medical claims

Communication

Teamwork

Education

High School Diploma

Job description

Medix Infusion is seeking an Insurance Specialist to verify insurance eligibility and benefits for infusion services, review medical necessity guidelines, and ensure accurate documentation. You will handle authorizations, predeterminations, and appeal requests, coordinating with Intake, Scheduling, Pharmacy, and Clinical teams to keep patient care on track.

The role requires 2-3 years in healthcare or medical claims billing, familiarity with Medicare/Medicaid policies, and strong communication