Senior Prior Authorization & Appeals Specialist

KabaFusion; Cerritos (CA); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

Competitive compensation

Benefits start on day one

401k with 4% match

PTO / Holidays

Life insurance

Employee assistance program

Learning & Development

Employee discounts

Referral program

Job summary

KabaFusion is seeking a skilled healthcare authorization specialist to manage complex eligibility, authorization, and financial assistance cases for home infusion services. The role focuses on escalations, second-level appeals, complex reimbursement issues, and removing payer barriers to patient access while ensuring compliance with payer requirements.

You will work with intake, clinical, pharmacy, and billing teams to ensure timely patient onboarding, accurate documentation, and adherence to

Qualifications

• High school diploma or equivalent required.
• Associate or bachelor’s degree in health care or related field preferred.

Responsibilities

• Manage escalated authorization cases with complex payer requirements.
• Lead second-level appeals with detailed documentation and payer communication.
• Troubleshoot Revenue Cycle Management issues related to authorization, denials, and reimbursement barriers.
• Manage challenging copayment assistance cases with foundations, manufacturers, and internal teams.
• Identify retraining needs and support intake training teams.
• Assist with intake, eligibility, and authorization workflows as needed.
• Serve as subject matter expert on authorization workflows and payer policies.
• Collaborate with intake, clinical, pharmacy, and billing teams for seamless patient onboarding.
• Identify risks to authorization approval or reimbursement and implement mitigation strategies.
• Assist with SOPs, policies, and training materials.
• Maintain accurate documentation for compliance and audit readiness.
• Identify trends in denials and recommend process improvements.
• Support projects requiring authorization, copay assistance, or eligibility expertise.

Skills

Prior authorization

Payer guidelines

RCM processes

Attention to detail

Communication skills

Independent work

Problem solving

Education

High school diploma or equivalent

Associate or bachelor’s degree in health care

Tools

CPR+ software

Microsoft Office

Job description

KabaFusion is seeking a skilled healthcare authorization specialist to manage complex eligibility, authorization, and financial assistance cases for home infusion services. The role focuses on escalations, second-level appeals, complex reimbursement issues, and removing payer barriers to patient access while ensuring compliance with payer requirements.

You will work with intake, clinical, pharmacy, and billing teams to ensure timely patient onboarding, accurate documentation, and adherence to