Authorization Specialist II

Full-time Authorization Specialist II

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 II at our corporate office located in Murfreesboro, TN. This position is responsible for obtaining prior authorizations for referrals for the infusion centers.

Essential Duties & Responsibilities

• Responsible for initializing prior medical/pharmacy authorization requests that are assigned. Follow the Prior Authorization Criteria for medications and submits 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. Reviews the clinical information for completeness for insurance requirements and follows up with any questions.
• Handle complex authorization requests and issues as needed.
• Perform duties and job functions in accordance with the policies and procedures established for the department and any other duties as assigned.

Requirements

The successful candidate will possess the following knowledge, skills and abilities:

• 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.