Authorization Specialist III - Healthcare

Authorization Specialist III

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 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.