Prior Authorization Pro: Crack the Case & Speed Patient Care

Pure Infusion; Phoenix (AZ); Sur place; USD 55 000 - 75 000; Plein temps

Résumé du poste

Pure Infusion seeks a detail-oriented Prior Authorization Specialist to manage the authorization process for infusion therapies. You will interpret clinical documentation, assess payer policies, and determine what is needed to get patients approved promptly.

You will handle a caseload of active authorizations, navigate Salesforce, WeInfuse, and AMD, and collaborate with providers, clinical teams, and internal stakeholders to keep cases moving and ensure timely patient care.

Qualifications

• 2–3 years of MA experience with direct prior authorization and biologic therapy.
• Experience with Salesforce, WeInfuse, and AMD.
• Certification or formal Medical Assistant training required.
• Proficient with EMRs and CRMs.

Responsabilités

• Process prior authorizations accurately and efficiently, including reviewing step therapy and payer requirements.
• Manage appeals and denials, escalating cases when necessary.
• Analyze insurance policies and obtain required documentation when cases don’t align with policy.
• Verify insurance benefits and determine INN/OON status across payers/states.
• Evaluate medical and pharmacy benefits to determine patient eligibility.
• Maintain clear, professional communication with providers, patients, and internal teams.
• Document all case-related conversations in Salesforce within required timeframes.
• Prioritize tasks to ensure timely completion and follow-up.
• Collaborate with PACs, clinical staff, and sales to gather case information.
• Investigate and resolve complex cases using critical thinking and problem-solving.
• Organize workload to meet performance goals and follow Intake standards.

Connaissances

Medical Assistant experience

Prior authorization experience

Salesforce

WeInfuse

AMD

EMRs/CRMs

Documentation habits

Formation

High School diploma or equivalent

Medical Assistant certification

Outils

Salesforce

WeInfuse

AMD

EMRs/CRMs

Description du poste

Pure Infusion seeks a detail-oriented Prior Authorization Specialist to manage the authorization process for infusion therapies. You will interpret clinical documentation, assess payer policies, and determine what is needed to get patients approved promptly.

You will handle a caseload of active authorizations, navigate Salesforce, WeInfuse, and AMD, and collaborate with providers, clinical teams, and internal stakeholders to keep cases moving and ensure timely patient care.