Prior Authorization Specialist - 258142

Medix™; Knoxville (TN); On-site; USD 52,000 - 75,000; Full time

Job summary

Medix is seeking an experienced Prior Authorization Specialist to join our healthcare team supporting patients requiring complex specialty medications, chemotherapy, and infusion treatments. The role ensures timely authorizations and minimizes delays in patient care.

The ideal candidate has at least 2 years of hands-on medical insurance verification and prior authorization, with a background in medications or specialty regimens, plus proficiency with payer portals and coding.

Qualifications

• Minimum 2 years of direct medical insurance verification and prior authorization experience.
• Experience obtaining prior authorizations for medications, specialty drugs, or infusion therapies.
• Familiarity with ICD-10, CPT, HCPCS coding and payor portals.
• Strong problem-solving, communication, and accuracy in fast-paced healthcare settings.

Responsibilities

• Initiate, submit, track, and secure timely prior authorizations for specialty medications, chemotherapy, and infusion regimens.
• Review patient charts and gather clinical documentation to support medical necessity.
• Submit authorization requests through major insurance payor portals and follow up by phone.
• Work with major regional payors, including BlueCross, Medicare/Medicare Advantage, and Humana.
• Navigate payor requirements and coordinate appeals and peer-to-peer processes when necessary.
• Maintain in-house buy-and-bill operations by addressing payor restrictions and authorization barriers.
• Monitor authorization status and communicate updates to physicians and clinic staff.
• Serve as liaison between Central Business Office, physicians, and clinical teams regarding insurance requirements and authorization status.
• Identify potential authorization issues early and resolve them.
• Maintain accurate documentation of all authorization activity with urgency.

Skills

Insurance verification

Prior authorization

Medical documentation

ICD-10 CPT HCPCS coding

Payor portals

Communication skills

Attention to detail

Tools

Availity

CoverMyMeds

Payor portals

Job description

We are seeking an experienced Prior Authorization Specialist to join a growing healthcare team supporting patients receiving complex specialty medications, chemotherapy, and infusion treatments. This role plays a critical part in ensuring necessary treatments are authorized and available to patients without unnecessary delays.

About the Role

The ideal candidate will have at least 2 years of hands-on medical insurance verification and prior authorization experience, with a strong background obtaining authorizations specifically for medications or specialty drug regimens.

Responsibilities

• Initiate, submit, track, and secure timely prior authorizations for specialty medications, chemotherapy, and infusion regimens.
• Review patient charts and gather clinical documentation, including physician notes, laboratory results, diagnosis codes, and treatment regimen information, to support medical necessity.
• Submit authorization requests through major insurance payor portals and follow up directly with payors by phone.
• Work with major regional payors, including BlueCross, Medicare/Medicare Advantage, and Humana.
• Navigate payor white-bagging requirements and coordinate appeals and peer-to-peer processes when necessary.
• Work to maintain in-house buy-and-bill operations by addressing payor restrictions and authorization barriers.
• Monitor authorization status and proactively communicate updates, delays, or issues to physicians and clinic staff.
• Serve as a liaison between the Central Business Office, physicians, and clinical teams regarding insurance requirements and authorization status.
• Identify potential authorization issues early and work to resolve them before they impact patient treatment.
• Maintain accurate documentation and ensure all authorization activity is completed with a high level of accuracy and urgency.

Qualifications

• Minimum 2 years of direct medical insurance verification and prior authorization experience.
• Demonstrated experience obtaining prior authorizations for medications, specialty drugs, or infusion therapies.
• Experience working with complex medical necessity requirements and clinical documentation.
• Working knowledge of ICD-10, CPT, and HCPCS coding.
• Proficiency with insurance payor portals, such as Availity, CoverMyMeds, and payor-specific websites.
• Strong problem-solving and follow-through skills.
• Excellent communication skills with the ability to provide proactive updates to physicians, clinical staff, and management.
• Exceptional attention to detail and accuracy in a fast-paced healthcare environment.

Required Skills

• Direct medical insurance verification and prior authorization experience.
• Experience obtaining prior authorizations for medications, specialty drugs, or infusion therapies.
• Experience with complex medical necessity requirements and clinical documentation.
• Knowledge of ICD-10, CPT, and HCPCS coding.
• Proficiency with insurance payor portals (Availity, CoverMyMeds, payor-specific websites).
• Strong problem-solving and follow-through.
• Exceptional attention to detail and accuracy in a fast-paced healthcare environment.

Preferred Skills

• Experience with oncology, hematology, chemotherapy, or specialty infusion authorizations.
• Experience with Athena IDX.
• Previous experience as a Medical Assistant (CMA), LPN, Financial Counselor, or in a similar clinical/financial healthcare role.
• Experience working in an oncology practice, infusion center, health system, or specialty medical practice.
• Buy-and-bill experience is highly preferred.

Schedule

• This is a 100% onsite position with three flexible standard start-time options:
• 7:30 AM – 4:00 PM
• 8:00 AM – 4:30 PM
• 8:30 AM – 5:00 PM

Interview Process

• One-step, onsite interview.
• Interviews are expected to take place Monday, Wednesday, or Thursday.
• Business casual dress.

Why This Opportunity?

• Choose from three standard start-time options.
• Make a direct impact on patient care by helping ensure critical treatments are authorized and available on time.
• Join a growing healthcare environment with increasing patient and provider volume.
• Opportunity to use and expand your expertise in specialty medication and prior authorization.

What We’re Looking For

This position is especially well-suited for Prior Authorization or Insurance Verification Specialists who have hands-on experience obtaining authorizations for specialty medications, chemotherapy, or infusion treatments. Experience with drug authorizations is strongly preferred, as this role involves navigating complex treatment regimens, payor requirements, and medical necessity guidelines.