Experienced Intake / Authorization Specialist

About AIS Healthcare

AIS Healthcare is a premier provider specializing in Targeted Drug Delivery (TDD) and Infusion Care solutions. Embracing a culture rooted in Innovation, Stewardship, and Unity, the organization is deeply committed to elevating quality and enriching patient lives through exceptional products and support services.

Role Overview

We seek a seasoned benefit verification and authorization professional to join our energetic team. Applicants must possess excellent communication capabilities, comprehensive knowledge of insurance collection procedures, and strict adherence to federal and state regulations governing benefit verification and authorization processes.

Key Responsibilities

• Expertise in processing patient insurance eligibility and benefits across diverse payers such as Aetna, Cigna, BCBS, Humana, Worker’s Compensation, Medicare, and Medicaid.
• Managing authorization workflows including handling Gaps, Pre-determinations, PCP Referrals, and Single Case Agreements efficiently.
• Entering insurance and authorization data precisely into electronic health record systems following Standard Operating Procedures (SOPs).
• Conducting diligent follow-ups on outstanding or expired authorizations and referrals.
• Evaluating authorization denials carefully and initiating appeals until resolution, exhaustion of options, or decision to cease appeal.
• Maintaining detailed documentation of all communications in line with departmental SOPs.
• Responding promptly to Quality Reviews as needed.
• Respecting patient privacy and confidentiality while upholding patients’ rights and responsibilities.
• Adhering rigorously to HIPAA standards and confidentiality requirements.
• Possessing and maintaining knowledge of National Drug Code (NDC) numbers, medication dosages, and infusion supplies.
• Keeping updated on insurance plans, medical terminology, billing, governmental regulations, and medical coding.
• Sharing insights and best practices with colleagues and collaborating as a team player.
• Exhibiting professionalism, respect, and consideration in all interactions.
• Performing other job-related duties as assigned.

Qualifications and Requirements

• Minimum high school diploma or GED equivalency required.
• Preferably 3 to 5 years of healthcare industry experience, with emphasis on Home Infusion or Intrathecal Pain Management experience favored.
• Sound judgment and ability to resolve complex issues consistent with applicable laws and policies.
• Strong verbal and written communication skills, capable of building relationships and prioritizing tasks effectively.
• Integrity, credibility, and a robust work ethic.
• Self-motivated, detail-focused, organized, and able to ensure task completion.
• Adept at handling multifaceted problems within the scope of responsibility.
• Proficiency in Microsoft Office suite, including Outlook, Word, and Excel.

Workplace and Benefits

AIS Healthcare offers comprehensive health, vision, and dental insurance packages, long-term disability coverage, life insurance, vacation benefits, and a 401(k) plan with a competitive employer match. This role features a 100% work from home opportunity along with prospects for professional growth in a supportive culture.

Additional Information

Applicants must complete the Culture Index Candidate Assessment as part of the application; failure to do so results in the application being disregarded. The assessment helps ensure alignment between candidate characteristics and role expectations, supporting AIS Healthcare’s collaborative and success-driven environment.

AIS Healthcare dedicates itself to delivering advanced sterile, patient-specific intrathecal pump medications and in-home intravenous infusion therapies, enhancing care for physicians and hospitals to achieve optimal patient outcomes.