Authorization Specialist

Position Summary

Submits initial authorizations and follows up in a timely manner. Coordinates subsequent authorization renewals and communicates information with all departments in an efficient and timely manner. Has a thorough understanding of all Payer Contracts. Assists Reimbursement team with authorization denials. Collaborates with case managers, payers, referral sources, home health agencies and intake staff to facilitate prompt initial authorizations and subsequent extensions/renewals. Communicates timely with the patient and the team any issues and assists in making other arrangements for the patient continuation of care. Serves as back up to the intake team for initial intakes. Updates both computerized and paper record keeping systems. And all other reimbursement department duties as assigned.

As an Authorization Specialist you will: obtain prior authorizations for new patients; maintain insurance authorizations for current patients; Re-verify insurance coverage for changes in medication orders; Research and follow up on authorization denials

Essential Job Functions

• Ensures Insurance verification and authorization is complete and processed in a timely manner. Obtains ongoing authorization for services in a proactive manner.

• Speaks knowledgeably regarding reimbursement issues.

• Ability to take complete and accurate intakes.

• Collaborates with care managers, payers, referral sources, home health agencies, and intake staff to facilitate patient coordination of care.

• Follows policies and procedures to obtain approval/denial from General Manager or designee regarding acceptance of client for services.

• Notifies patients/ caregivers regarding coverage and payment responsibilities. Communicates insurance limitations and co-payment responsibilities.

• Processes all electronic authorizations via payer web-sites as applicable.

• Runs reports for authorization issues and presents to Reimbursement Manager.

• Adds, corrects, and notes payer changes in multiple electronic record keeping systems.

• Demonstrates professional demeanor when interacting with clients, insurance companies, referral sources and Infusion Solutions staff.

• Document all conversations, ref #, Phone number called, who you spoke to.

• Actively participates in morning report in regards to pending intakes.

• Speaks knowledgeably to the scope of services that Infusion Solutions can provide.

• Creates progress notes in accordance with established procedures.

Duties, responsibilities, and activities may change at any time with or without notice to meet organizational needs.

Supervisory Responsibilities

• This position has no supervisory responsibilities.

Required Education, Licensure & Experience

All requirements below are job-related and consistent with business necessity.

• High school graduate or general education degree (GED).

• Two (2) years insurance experience working with Medicare, Medicaid and third party insurance.

• Ability to communicate effectively in English, both verbally and in writing.

Preferred Education & Experience

Preferred qualifications are not required but are job-related and consistent with business necessity.

• Home infusion experience preferred.

• Prior experience with insurance authorization and prior authorization processes.

• Familiarity with Medicare, Medicaid, and commercial payer guidelines.

• Experience in a healthcare, pharmacy, or specialty infusion setting.

• Knowledge of medical terminology and documentation requirements.

• Additional languages preferred.

Core Competencies

• Demonstrates support and willingness to assist with sales activities.

• Evaluates the financial appropriateness of new referrals.

• Conducts benefits investigation and verification.

• Ensures reliability and consistent follow-through on assigned tasks to meet quality standards.

• Manages and updates authorizations as needed.

• Excellent written and verbal communication skills.

• Exceptional customer service skills.

• Strong problem-solving abilities with the capacity to manage multiple variables.

• Professional demeanor when interacting with clients, insurance companies, and referral sources.

• Computer proficiency, including medical terminology and knowledge of Medicare, Medicaid, and third-party payer guidelines.

Physical Demands

The following physical demands are representative of those required to successfully perform the essential functions of this position. Reasonable accommodations may be made where appropriate.

• Primarily sedentary position requiring prolonged periods of sitting.

• Frequent use of hands for typing, data entry, and phone communication.

• Occasional standing, walking, and reaching.

• May require light lifting of materials up to 25 pounds.

Work Environment

• Office-based setting with a quiet to moderate noise level.

• Minimal exposure to environmental hazards or extreme conditions.

• Regular use of computers, phones, and standard office equipment.

• Requires the ability to hear and communicate clearly with staff, providers, and patients.

Additional Eligibility Requirements

• Must pass a pre-employment background check and drug screen per company policy and applicable state law.
• Must maintain required immunizations per accreditation standards and company policy.
• Must provide proof of eligibility to work in the U.S.
• Must comply with company policies, codes of conduct, and required trainings.
• Must hold required licenses or certifications, if applicable.
• Must be available for required shifts or travel, if applicable.
• Must meet role-specific physical, technical, or experience requirements, if applicable.