Authorization Specialist III at TwelveStone Health Partners Inc

Murfreesboro, Tennessee, United States -

Full Time

Start Date

Immediate

Expiry Date

05 Jun, 26

Salary

0.0

Posted On

07 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Authorization, Intake, Insurance Verification, Denials, Appeals, Clinical Information Review, Prior Authorization, Payer Communication, EMR Systems, HCPC Coding, ICD-10, Critical Thinking, Problem Solving, Multitasking, Phone Etiquette, 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. TwelveStone Health Partners supports the transition from acute to post-acute care environments and the journey from sickness to health. Summary: We are currently hiring for the position of full-time Authorization Specialist III based out of Corporate office location in Murfreesboro, TN. This position 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 role also includes intake responsibilities such as verifying insurance, determining billing avenue, and communicating with patients regarding their referrals and coverage. Essential Duties & Responsibilities Handle complex and urgent authorization requests and issues, including denials and appeals. Prepare and submit appeal documentation and follow up with payers to ensure resolution. Obtain and review clinical information (e.g., medical history, diagnosis, labs) for completeness and compliance. Initiate and manage prior medical/pharmacy authorization requests, following criteria and submitting to insurance companies. 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 Requirements Education: High School Diploma or GED required. Preferred: Pharmacy Technician License (PT), CPhT certification, or professional license (LPN, Medical Assistant, etc.) Experience: 2+ years of experience in medical intake, pharmacy authorization, or healthcare office settings. Experience with specialty/IV pharmacy, HCPC coding, ICD-10, EMR systems, and insurance portals. Proven ability to work in high-productivity environments with performance metrics. Functional Competencies: Attention to detail, critical thinking, problem solving, verbal and written communication, teamwork, collaboration, initiative, follow-through, multitasking, phone etiquette, dependability, and ability to work independently.

Responsibilities

This role involves serving as a subject matter expert to manage complex and urgent prior authorization requests, including handling denials and submitting appeals to ensure timely dispensing and billing of patient care. Responsibilities also include intake duties such as verifying insurance coverage and communicating referral and coverage details to patients.