Prior Authorization Specialist

Infusion4Health Inc; Brea (CA); On-site; USD 32,000 - 37,000; Full time

Job summary

Infusion for Health is seeking a Prior Authorization Specialist in Brea, CA to support patient care operations. This full-time, onsite role requires timely submission, accurate documentation, and collaboration with insurers and healthcare teams to expedite approvals.

Applicants should have at least 2 years of infusion or pharmacy prior authorization experience and knowledge of Medicare/Medicaid guidelines. The position emphasizes multi-tasking in a fast-paced environment and adherence to company

Qualifications

• At least 2 years experience in infusion or pharmacy prior authorization is required.
• At least 2 years of experience applying knowledge of Medicare, Medicaid, and Managed Care reimbursement guidelines.
• Ability to effectively handle multiple priorities within a changing environment, emphasizing paperless workflow.
• Experience in diagnosing, isolating, and resolving complex issues and recommending and implementing strategies to resolve problems.

Responsibilities

• Responsible for ensuring timely, accurate submission follow-up and approval of Authorizations, with urgency, high-quality communication with patients, insurance and stakeholders.
• Review the accuracy and completeness of the information requested and ensure all supporting documents are present.
• Assist with medical necessity documentation to expedite approvals and ensure appropriate follow-up.
• Collaborate with other departments to assist in obtaining prior authorizations/appeals.
• Document all interactions with insurance companies or other stakeholders within the company system.
• Document all prior authorization information, including approval dates, billing units, procedure codes, and prior authorization number in the patient profile.
• Proactively work on prior authorizations that are due to be expired.
• Complete duties per leadership direction.
• Other duties as assigned

Job description

Prior Authorization Specialist

Brea, CA, US

4 days ago Requisition ID: 2296

Salary Range: $23.00 To $27.00 Hourly

Prior Authorization Specialist

Job Description

Infusion for Health is a referral-based infusion center that services all providers in multiple locations in California, Arizona, Nevada, Washington, Colorado, and Missouri. Our center is unique and offers individual comfortable private rooms for our patients. Our mission is to provide exceptional service in the administration of infusion therapy in a comfortable, patient-focused environment by providing exemplary professional clinical care.

Our company is continuing to grow and we\'re looking to add a Prior Authorization Specialist to support our patient care operations department.

This is a full-time, 5 days a week position, onsite at our Brea HQ office.

Key Responsibilities:

• Responsible for ensuring timely, accurate submission follow-up and approval of Authorizations. Work with urgency, high-quality and high communication with patients, insurance and additional stakeholders as needed.
• Review the accuracy and completeness of the information requested and ensure that all supporting documents are present
• Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
• Collaborate with other departments to assist in obtaining prior authorizations/appeals
• Document all interactions with insurance companies or other stakeholders within the company system
• Document all prior authorization information, including approval dates, billing units, procedure codes, and prior authorization number in the patient profile
• Proactively work on prior authorizations that are due to be expired
• Conduct job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards
• Completes all required duties, projects, and reports in a timely fashion on a daily, weekly, or monthly basis per the direction of the leadership.
• Other duties as assigned

Education and/or Experience Needed:

• At least 2 years experience in infusion or pharmacy prior authorization is required
• At least 2 years of experience applying knowledge of Medicare, Medicaid, and Managed Care reimbursement guidelines
• Ability to effectively handle multiple priorities within a changing environment, emphasizing paperless workflow
• Experience in diagnosing, isolating, and resolving complex issues and recommending and implementing strategies to resolve problems.