Authorization Specialist I

Who We Are TwelveStone Health Partners focuses on medication needs of patients with chronic, complex, and rare conditions. For more than 35 years, we have dedicated ourselves to finding new ways to deliver care designed around the patient. Our portfolio includes 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. We provide access to advanced medications and support patients, while simplifying treatment for providers by eliminating administrative and clinical burdens. We are licensed in 50 states. Position Overview We are hiring for the role of Authorization Specialist I at our corporate office located in Murfreesboro, TN. The position is responsible for obtaining prior authorizations for referrals to the infusion centers. Essential Duties & Responsibilities Initialize prior medical/pharmacy authorization requests that are assigned. Follow the Prior Authorization Criteria for medications and submit 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. Review the clinical information for completeness for insurance requirements and follow up with any questions. Assist with 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 #J-18808-Ljbffr TwelveStone Health Partners