Authorization Specialist I at TwelveStone Health Partners Inc

Murfreesboro, Tennessee, United States -

Full Time

Start Date

Immediate

Expiry Date

28 Sep, 26

Salary

0.0

Posted On

30 Jun, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Prior Authorization, Insurance Portals, Clinical Documentation Review, Medical History Analysis, Phone Etiquette, Problem Solving, Critical Thinking, Multi-tasking, Verbal Communication, Written Communication, Teamwork, Collaboration

Industry

Hospitals and Health Care

Description

Description Who We are: TwelveStone Health Partners is focused on the medication needs of patients with chronic, complex and rare conditions. For more than 35 years, TwelveStone Health has been dedicated to finding new ways to deliver care designed around the patient. Chronic conditions include Multiple Sclerosis, NMOSD, Myasthenia Gravis, CIDP, ITP, Migraine Prevention, Crohn’s Disease, Ulcerative Colitis, Plaque Psoriasis, Alpha 1 Antitrypsin Deficiency, Primary Immunodeficiency, hATTR Amyloidosis, Thyroid Eye Disease, and many others. For patients, we provide access to the most advanced medications, along with the personal and financial support patients need to live with chronic conditions. For providers, we simplify treatment for complex conditions by eliminating the administrative and clinical burdens placed on your practice when patients need innovative specialty medications. TwelveStone Health Partners supports the transition from acute to post-acute care environments and the journey from sickness to health. We are currently licensed in 50 states. We are currently hiring for the position of Authorization Specialist I at our corporate office located in Murfreesboro, TN. This position is responsible for obtaining prior authorizations for referrals for the infusion centers. Essential Duties & Responsibilities: Responsible for initializing prior medical/pharmacy authorization requests that are assigned. Follow the Prior Authorization Criteria for medications and submits requests. Communicate with insurance companies to pre-certify/authorize medications. Obtain clinical information (including but not limited to medical history, diagnosis, and any relevant lab reports) necessary to complete the Prior Authorization. Reviews the clinical information for completeness for insurance requirements and follows up with any questions. Assist with any denied claims to resolve potential mistakes by providing clinical information and/or coordinating with appropriate departments. Perform duties and job functions in accordance with the policies and procedures established for the department and any other duties as assigned. Requirements Education: High School Diploma or GED required. Experience: One-year related experience and/or training with a healthcare organization, retail, or mail order pharmacy, or PBM. Experience with completing referrals and navigating insurance portals and orders. Experience working in a highly productive department with strong metrics accountability/ownership. Functional Competencies: Attention to detail, critical thinking, problem solving, approachable, phone etiquette, dependable, verbal and written communication, teamwork, cooperation, collaboration, judgment, initiative, follow-through, Ability to prioritize and multi-task when presented with multiple duties, Self-starter with the ability to work independently and as part of a team.

Responsibilities

Responsible for initializing and obtaining prior medical and pharmacy authorizations for infusion center referrals. This includes communicating with insurance companies and gathering necessary clinical information to resolve denied claims.