Senior Authorization Specialist — Medical Access & Appeals

TwelveStone Health Partners Inc; Murfreesboro (TN); On-site; USD 42,000 - 64,000; Full time

Job summary

TwelveStone Health Partners is hiring for a full-time Authorization Specialist III at our Murfreesboro, TN location. This role serves as a subject matter expert, collaborating with referral sources, insurance providers, and internal teams to ensure timely and accurate authorization, dispensing, and billing of patient care.

The position also includes intake responsibilities such as verifying insurance, determining billing avenues, and communicating with patients regarding referrals and coverage.

Qualifications

• 2+ years of experience in medical intake or healthcare office settings.
• Experience with specialty/IV pharmacy, HCPC coding, ICD-10, EMR systems.
• Proven ability to work in high-productivity environments with performance metrics.

Responsibilities

• Handle complex and urgent authorization requests and issues, including denials and appeals.
• Prepare and submit appeal documentation and follow up with payers.
• Obtain and review clinical information for completeness and compliance.
• Initiate and manage prior medical/pharmacy authorization requests.
• Verify insurance coverage and ensure documentation meets payer requirements.
• Manage communication via phone, email, fax, and web portals with referral sources, insurance providers, and internal departments.
• Other duties as assigned.

Skills

Attention to detail

Critical thinking

Problem solving

Verbal communication

Written communication

Teamwork

Collaboration

Initiative

Follow-through

Multitasking

Phone etiquette

Dependability

Independent work

Education

High School Diploma or GED

Pharmacy Technician License (PT)

CPhT certification

Professional license (LPN, Medical Assistant, etc.)

Job description

TwelveStone Health Partners is hiring for a full-time Authorization Specialist III at our Murfreesboro, TN location. This role serves as a subject matter expert, collaborating with referral sources, insurance providers, and internal teams to ensure timely and accurate authorization, dispensing, and billing of patient care.

The position also includes intake responsibilities such as verifying insurance, determining billing avenues, and communicating with patients regarding referrals and coverage.