Prior Authorization Specialist - Hybrid -remote

Job Description

Job Description

My client, a leader patient-centered infusion and specialty-care platforms company is hiring for Prior Authorization Specialists to work in Sandy Utah city office

This position manages prior authorizations to support timely patient care. The specialist collaborates with providers, clinical teams, PACs, and sales representatives while managing 30+ active authorizations. They track case progress, meet deadlines, and help ensure operational efficiency and patient satisfaction.

Pay : $24-$28, depending on experience  

Type: Temp to hire

Start date: TBD Oct - Nov

Location :     Sandy, UT 84070  - hybrid or remote after 6 months (or sooner depends on performance).   

Schedule : Monday-Friday  8AM to 5PM 

Training :   2 weeks onsite.  The first week is classroom, the second week is shadowing.

Dress Code: Business casual, nice jeans and top/blouse

Benefits :    Benefits through Remx and full package of benefits after converted to perm position.

Responsibilities

·       Processes prior authorizations accurately and efficiently, including reviewing step therapy, minimum authorization requirements, and payer-preferred medications.

·       Manages appeals and denials, escalating cases when necessary, and follows appropriate payer protocols.

·       Analyzes insurance policies for each case and communicates with internal teams or providers to obtain needed documentation  

·       Verifies insurance benefits and determines in-network  or out-of-network status across various payers and states  

·       Evaluates medical and pharmacy benefits to determine patient eligibility for treatment.

·       Maintains clear, professional communication with providers, patients, internal teams, and stakeholders.

·       Accurately documents all case-related conversations and updates within Salesforce within required timeframes.

·       Collaborates with internal team members to gather or clarify case information.

·       Investigates and resolves complex cases  

Requirements

·       Minimum 2-3 years of experience as a Medical Assistant (MA), with direct prior authorization

·       Knowledge of commercial and Medicare Advantage policies, including Local Coverage Determinations (LCDs).

·       High School diploma or equivalent required.

·        Biologic therapy authorization experience preferred but no required

·       Proficiency with EMRs, PMS and prior authorization systems

·       Strong experience working with systems like Salesforce, WeInfuse, and AMD.

·       Excellent communication and customer service skills  

·       Highly organized and multitasking skills