Authorization Specialist

Authorization Specialist

Addison Group is partnering with a healthcare organization specializing in infusion services seeking experienced Authorization Specialist to support high-volume insurance reverification and authorization needs. This opportunity is ideal for someone with strong insurance verification and complex medical benefit authorization experience who can independently research and resolve coverage issues.

The Authorization Specialist will be responsible for verifying patient insurance coverage, obtaining prior authorizations, and resolving complex authorization issues for specialty healthcare services. This position will focus heavily on annual insurance reverifications, updating patient coverage information, and handling escalated authorization cases that require additional investigation and payer follow-up.

Key responsibilities include:

• Complete insurance eligibility and benefits verification for new and existing patients.
• Perform annual insurance reverifications to confirm updated coverage and benefits.
• Contact patients to obtain updated insurance information and resolve coverage discrepancies.
• Obtain and manage prior authorizations under patients' medical benefits for infusion and specialty services.
• Research and resolve complex authorization rejections, coverage issues, and escalated cases.
• Communicate directly with insurance payers regarding authorization requirements, benefit limitations, and coverage determinations.
• Review clinical documentation and coordinate with providers to support authorization requests and appeals.
• Assist with peer-to-peer reviews and coverage appeals when necessary.
• Explain insurance benefits, out-of-pocket costs, deductibles, and patient financial responsibilities.
• Accurately document insurance verification and authorization activity within EMR systems.
• Collaborate with internal teams and third-party vendors to resolve outstanding authorization issues.
• Identify recurring payer issues and recommend opportunities to improve authorization workflows.

Requirements include:

• Strong insurance verification and benefits eligibility experience required.
• Extensive prior authorization experience required, including handling complex or escalated authorization cases.
• Must have experience obtaining authorizations under medical benefits, not solely pharmacy or medication authorizations.
• Infusion experience strongly preferred; oncology, rheumatology, specialty pharmacy, or other specialty healthcare experience will also be considered.
• Experience reviewing insurance coverage, benefit limitations, and patient financial responsibility.
• Strong knowledge of commercial insurance payer requirements and authorization processes.
• Experience working within an EMR system required.
• Ability to research authorization denials, obtain supporting documentation, and follow cases through resolution.
• Comfortable communicating directly with patients, insurance carriers, and clinical teams.
• Strong attention to detail, problem-solving, and organizational skills.
• Ability to work independently in a fast-paced, high-volume remote environment.
• Reliable, adaptable, and team-oriented.

Additional details:

• 100% remote with preference for candidates located in the Central Time Zone.
• MondayFriday, with schedules typically 7:00 AM4:00 PM or 8:00 AM5:00 PM.
• Virtual interview process.
• Target start date: December 1, 2026. - Cannot be working

Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request.