Specialty Pharmacy Access & Authorization Specialist

Innovative Hematology, Inc.; Indianapolis (IN); On-site; USD 55,000 - 75,000; Full time

Job summary

Innovative Hematology, Inc. (IHTC) in Indianapolis, IN, seeks an experienced Utilization Review Specialist to manage prior authorizations, medical necessity reviews, and payer requirements for specialty medications.

You will collaborate with prescribers, nurses, pharmacists, and payers to ensure timely access while complying with HIPAA, Medicare, Medicaid, and payer guidelines. Responsibilities include gathering clinical documentation, submitting authorization requests, tracking follow-ups, and

Qualifications

• Proficiency in reviewing and interpreting clinical documentation, lab results, payer policies, and medical necessity criteria.
• Familiarity with HIPAA, Medicare, Medicaid, and payer guidelines.
• Experience with utilization review, prior authorization, reauthorization, and appeals processes.

Responsibilities

• Review referrals to identify insurance requirements and prior authorization needs.
• Submit and track prior authorization requests via portals, fax, or calls.
• Gather and validate clinical documentation to support approvals.
• Monitor status with payers and expedite approvals to minimize delays.
• Coordinate with clinicians and staff to obtain missing information and ensure accurate submissions.
• Evaluate denials and assist with appeals when possible.
• Maintain records of authorization activities and outcomes in EHR systems.
• Identify trends in denials and provide process improvement recommendations.

Skills

Clinical documentation review

Payer policies

Medical necessity criteria

EHR systems

Microsoft Office

Communication skills

Time management

Team collaboration

Education

High school diploma or GED

Tools

Payer portals

Pharmacy management systems

Job description

Innovative Hematology, Inc. (IHTC) in Indianapolis, IN, seeks an experienced Utilization Review Specialist to manage prior authorizations, medical necessity reviews, and payer requirements for specialty medications.

You will collaborate with prescribers, nurses, pharmacists, and payers to ensure timely access while complying with HIPAA, Medicare, Medicaid, and payer guidelines. Responsibilities include gathering clinical documentation, submitting authorization requests, tracking follow-ups, and