Prior Authorization Specialist at Infusion4Health Inc

Brea, California, United States -

Full Time

Start Date

Immediate

Expiry Date

23 Jul, 26

Salary

27.0

Posted On

24 Apr, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Prior authorization, Infusion therapy, Pharmacy authorization, Medicare, Medicaid, Managed care, Reimbursement guidelines, Medical necessity documentation, Insurance communication, Microsoft Excel, Microsoft Word, Problem solving, Data documentation, Appeals processing

Industry

Hospitals and Health Care

Description

Infusion for Health is a referral-based infusion center that services all providers in multiple locations in California, Arizona, Nevada, Washington, Colorado, and Missouri. Our center is unique and offers individual comfortable private rooms for our patients. Our mission is to provide exceptional service in the administration of infusion therapy in a comfortable, patient-focused environment by providing exemplary professional clinical care. Our company is continuing to grow and we're looking to add a Prior Authorization Specialist to support our patient care operations department. This is a full-time, 5 days a week position, onsite at our Brea HQ office. Key Responsibilities: * Responsible for ensuring timely, accurate submission follow-up and approval of Authorizations. Work with urgency, high-quality and high communication with patients, insurance and additional stakeholders as needed. * Review the accuracy and completeness of the information requested and ensure that all supporting documents are present * Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed * Collaborate with other departments to assist in obtaining prior authorizations/appeals * Document all interactions with insurance companies or other stakeholders within the company system * Document all prior authorization information, including approval dates, billing units, procedure codes, and prior authorization number in the patient profile * Proactively work on prior authorizations that are due to be expired * Conduct job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards * Completes all required duties, projects, and reports in a timely fashion on a daily, weekly, or monthly basis per the direction of the leadership. * Other duties as assigned Education and/or Experience Needed: * At least 2 years experience in infusion or pharmacy prior authorization is required * At least 2 years of experience applying knowledge of Medicare, Medicaid, and Managed Care reimbursement guidelines * Ability to effectively handle multiple priorities within a changing environment, emphasizing paperless workflow * Experience in diagnosing, isolating, and resolving complex issues and recommending and implementing strategies to resolve problems. * Intermediate level skills in Microsoft Excel & Word The hourly pay range for this role is expected to be between $24-$27. Actual base pay could vary based on factors including but not limited to experience, subject matter expertise, geographic location where work will be performed, and the applicant's skill set. The base pay is just one component of the total compensation package for employees. Other rewards may include an annual cash bonus and a comprehensive benefits package. Monday -Friday

Responsibilities

The Prior Authorization Specialist is responsible for the timely submission, follow-up, and approval of authorizations for infusion therapy patients. They must collaborate with insurance companies and internal departments to ensure accurate documentation and resolve any authorization issues.