Prior Authorization Specialist

Prior Authorization Specialist Behind every approved infusion treatment is a Prior Authorization Specialist who navigated payer policy, step therapy requirements, and paperwork so the patient never had to. We're looking for someone who thrives on solving that puzzle quickly and accurately. Why This Role Feels Different This isn't a repetitive data-entry job. Every case is its own investigation, requiring you to interpret clinical documentation, understand payer policy, and figure out exactly what it will take to get a patient's treatment approved. You’ll manage a real caseload of active authorizations, work across systems like Salesforce, WeInfuse, and AMD, and collaborate daily with providers, clinical teams, and internal stakeholders to keep cases moving. The work you do directly determines how quickly patients get the treatment they need. If you like being the person who cracks the case and gets things unstuck, this role gives you that challenge every day. The Job The Prior Authorization Specialist is a vital team member responsible for efficiently managing the prior authorization process to ensure seamless patient care and timely treatment. This role requires a solid understanding of medical benefits, step therapy, and authorization policies, along with exceptional organizational, communication, and problem-solving skills. You will manage a caseload of at least 30 active authorizations and skillfully navigate systems such as Salesforce, WeInfuse, and AMD to track and update case progress, send communications, and meet critical deadlines. This role is key to maintaining operational efficiency and directly contributes to Pure Infusion's standard of excellence and patient satisfaction. Key Responsibilities Process prior authorizations accurately and efficiently, including reviewing step therapy, minimum authorization requirements, and payer-preferred medications. Manage appeals and denials, escalating cases when necessary, and follow appropriate payer protocols. Analyze insurance policies for each case and communicate with internal teams or providers to obtain needed documentation when a case does not align with policy. Verify insurance benefits and determine in-network (INN) or out-of-network (OON) status across various payers and states under Intake standards. Evaluate medical and pharmacy benefits to determine patient eligibility for treatment. Maintain clear, professional communication with providers, patients, internal teams, and stakeholders. Accurately document all case-related conversations and updates within Salesforce within required timeframes. Prioritize personal tasks and authorizations to ensure timely completion and follow-up. Collaborate with internal team members, including PACs, clinical staff, and sales, to gather or clarify case information. Investigate and resolve complex cases using strong critical thinking and problem-solving skills. Organize and manage authorization workload efficiently to meet performance goals. Follow Intake standards for accuracy and completion. The Ideal Candidate We are looking for someone who is highly organized, detail oriented, and energized by solving complex cases. Ideal candidates will: Bring proven ability to interpret clinical documentation and understand commercial and Medicare Advantage policies, including Local Coverage Determinations (LCDs). Communicate clearly and professionally with both clinical teams and patients. Manage multiple priorities confidently in a fast-paced environment. Bring strong documentation habits and time management skills. Required Qualifications Minimum 2-3 years of experience as a Medical Assistant (MA), with direct prior authorization and biologic therapy experience. Strong experience working with systems like Salesforce, WeInfuse, and AMD. High School diploma or equivalent required. Certification or formal training as a Medical Assistant required. Biologic authorization experience required. Proficiency with EMRs, CRMs (Salesforce), and prior authorization systems. Comfortable working in software like a PMS or EMR to track information, schedule, and make notes. Ability to meet U.S. employment and eligibility requirements. Preferred Qualifications Background in a specialty field such as Rheumatology, Gastroenterology, Dermatology, Neurology, or Immunology preferred. Why Join Pure Infusion? At Pure Infusion, you will find a role where your work matters in a direct and personal way. You will be part of a team that is building a better healthcare experience for patients, providers, and employees. If this resonates with you, we would love to meet you. Thank you for considering a career with Pure Infusion. We look forward to the opportunity to work together. About Pure Infusion Pure Infusion is a fast-growing healthcare company and a leader in chronic-condition infusion therapy. We deliver a personalized, private, and meaningful infusion experience for patients who often need ongoing care and consistency. Pure Infusion has been recognized as one of Utah's fastest-growing companies, and we believe that growth is a reflection of our people, purpose, values, and patient-first culture. Our patients are referred by specialty physicians for biologic and other infusion therapies, often related to autoimmune disorders or primary deficiencies. These patients need more than an appointment. They need a place that feels calm, professional, comfortable, and human. Our Core Values We live by four core values that define our culture and guide our hiring: People-Obsessed We care deeply about patients, teammates, referring providers, and every person who interacts with Pure Infusion. Relentlessly Improving We look for ways to make every visit, every process, and every interaction better than it was yesterday. Innovators We are willing to challenge old healthcare assumptions and build a better model for patients and teams. Grateful We serve with humility, appreciate the people around us, and believe gratitude should turn into action. Schedule and Benefits Snapshot Our regular hours are generally Monday through Friday, 8 a.m. to 5 p.m., with most weekends and holidays off. In addition to a competitive hourly rate, we offer: Competitive hourly rate 401(k) Matching Health, Vision, and Dental Insurance Over 20 days of paid time off annually One paid community service day each year to give back in a way that matters to you, either with your clinic, with the corporate team, or through a community cause you personally care about The pay range for this role is: 24 - 28 USD per hour (Remote) #J-18808-Ljbffr Remote Jobs