Remote Prior Authorization Specialist

AleraCare Holdings, LLC; Phoenix (AZ); Remote; USD 33,000 - 39,000; Full time

Benefits offered by this job

Competitive hourly rate

401(k) Matching

Health, Vision, and Dental Insurance

Over 20 days of paid time off annually

One paid community service day

Job summary

Pure Infusion is seeking a detail-oriented Prior Authorization Specialist to manage a caseload of active authorizations, navigate systems like Salesforce, WeInfuse, and AMD, and collaborate with clinicians to secure timely treatments for patients.

This role emphasizes understanding payer policies, step therapy, and accurate documentation, with a focus on patient access and efficiency in a fast-paced environment.

Qualifications

• Minimum 2–3 years as a Medical Assistant with direct prior authorization and biologic therapy experience.
• Strong experience with Salesforce, WeInfuse, and AMD.

Responsibilities

• Process prior authorizations accurately and efficiently, reviewing step therapy and payer requirements.
• Manage appeals and denials; escalate cases when needed and follow payer protocols.
• Analyze insurance policies and obtain documentation when cases do not align with policy.
• Verify insurance benefits and determine INN/OON status across payers and states.
• Evaluate medical and pharmacy benefits to determine patient eligibility.
• Maintain clear, professional communication with providers, patients, internal teams, and stakeholders.
• 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 with strong problem-solving skills.
• Organize authorization workload to meet performance goals.
• Follow Intake standards for accuracy.

Skills

Prior authorization

Medical Assistant

Salesforce

WeInfuse

AMD

EMRs/CRMs

Communication

Education

High School diploma or equivalent

Medical Assistant certification

Tools

Salesforce

WeInfuse

AMD

Job description

Pure Infusion is seeking a detail-oriented Prior Authorization Specialist to manage a caseload of active authorizations, navigate systems like Salesforce, WeInfuse, and AMD, and collaborate with clinicians to secure timely treatments for patients.

This role emphasizes understanding payer policies, step therapy, and accurate documentation, with a focus on patient access and efficiency in a fast-paced environment.