Prior Authorization Pro: Streamline Medical Approvals

Pure Infusion; Sandy (UT); On-site; USD 52,000 - 75,000; Full time

Job summary

Pure Infusion Suites in Utah is seeking a Prior Authorization Specialist to manage the prior authorization process efficiently, ensuring seamless patient care and timely treatment. The role requires strong knowledge of medical benefits, step therapy, and payer policies, with excellent organization.

You will collaborate with providers, clinical teams, PACs, and sales, using Salesforce, WeInfuse, and AMD to track progress, send updates, and meet critical deadlines.

Qualifications

• Minimum 2-3 years as a Medical Assistant (MA) with prior authorization and biologic therapy experience.
• Proven ability to interpret clinical documentation and understand commercial and Medicare Advantage policies.
• Strong experience with Salesforce, WeInfuse, and AMD.
• Background in Rheumatology, Gastroenterology, Dermatology, Neurology, or Immunology preferred.
• Excellent communication and customer service with clinical teams and patients.
• Highly organized and able to multitask in fast-paced environments.
• Strong documentation and time management skills.

Responsibilities

• Processes prior authorizations accurately and efficiently, including reviewing step therapy, minimum authorization requirements, and payer-preferred medications.
• Manages appeals and denials, escalating cases when necessary, and follows appropriate payer protocols.
• Analyzes insurance policies for each case and communicates with internal teams or providers to obtain needed documentation when the case does not align with policy.
• Verifies insurance benefits and determines in-network (INN) or out-of-network (OON) status across various payers and states under Intake standards.
• Evaluates medical and pharmacy benefits to determine patient eligibility for treatment.
• Maintains clear, professional communication with providers, patients, internal teams, and stakeholders.
• Accurately documents all case-related conversations and updates within Salesforce within required timeframes.
• Prioritizes personal tasks and authorizations to ensure timely completion and follow-up.
• Collaborates with internal team members (e.g., PACs, clinical staff, sales) to gather or clarify case information.
• Investigates and resolves complex cases using strong critical thinking and problem-solving skills.
• Organizes and manages authorization workload efficiently to meet performance goals.
• Follow and produce by Intake standards for accuracy and completion standards.

Job description

Pure Infusion Suites in Utah is seeking a Prior Authorization Specialist to manage the prior authorization process efficiently, ensuring seamless patient care and timely treatment. The role requires strong knowledge of medical benefits, step therapy, and payer policies, with excellent organization.

You will collaborate with providers, clinical teams, PACs, and sales, using Salesforce, WeInfuse, and AMD to track progress, send updates, and meet critical deadlines.