Infusion Prior Authorization Specialist

Infusion Prior Authorization Specialist

Responsible for ensuring all pre-service accounts are financially cleared and secured prior to the date of service. The specialist is responsible for obtaining and verifying accurate insurance information, benefit validation, and authorizations. This is a key position that begins the overall patient experience and initiates the billing process for any services provided by the practice.

• Contact insurance carriers utilizing telephone and/or payer websites to verify patient eligibility, benefits, authorization requirements.
• Ensure all patients are compliant w/individual criteria for both the drug manufacture and insurance company medical policy.
• Determine procurement methods such as buy and bill, specialty pharmacy, or pharmaceutical free drug program.
• Coordinate delivery of infusion medications based on procurement method.
• Coordinate with Infusion scheduler to ensure patients are scheduled promptly
• Follow up on pending patients' status regularly to ensure timely completion of script to chair.
• Request, track and obtain pre-authorizations prior to services being performed.
• Apply knowledge of medical terminology and general medical office procedures.
• Communicate any insurance coverage and/or authorization changes or trends among team.
• Maintain level of productivity suitable for the department.
• Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.

Maintains a professional relationship and positive attitude with co-workers, patients and all M.I.N.D staff.

• Strives to learn more and receptive to new challenges and opportunities.
• Displays enthusiasm toward the work and the mission of M.I.N.D.

• High School Diploma or GED.
• Demonstrated knowledge of insurances
• 1+ year experience in insurance verification, including navigating websites for online benefit review.
• Knowledge of CPT and ICD-10 codes.
• Excellent computer, multi-tasking and phone skills.
• The ability to work well under pressure to address time sensitive deadlines.
• Problem solving, time management and exceptional interpersonal skills.

This job operates in a medical office facility.

This position requires the ability to sit for long periods of time, view computer screens for long period of time, answer calls on a multi-line phone system, writing, reading and note taking.

This is a full-time position. Days and hours of work are Monday through Friday, varying hours between 8:00 a.m. to 4:30 p.m.

• Travel – none

Other duties may be assigned.