Prior Authorization Specialist

Infusion for Health; Brea (CA); On-site; USD 23,000 - 27,000; Full time

Job summary

Infusion For Health in Brea, CA is seeking a Prior Authorization Specialist to join our patient care operations. This full-time onsite role focuses on timely submission, accuracy, and collaboration with patients and insurers to secure approvals.

Responsibilities include reviewing requests, ensuring documents are complete, assisting with medical necessity, coordinating with departments, and logging all interactions in the system.

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. 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

Skills

Prior authorization

Insurer coordination

Patient communication

Job description

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Prior Authorization Specialist

Brea, CA, US

3 days ago Requisition ID: 2375

Salary Range: $23.00 To $27.00 Annually

Join Infusion For Health as a Prior Authorization Specialist!

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 guidelinesAbility 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.