Authorization Specialist

Job Overview

This full-time role involves handling initial authorization requests directed to assigned insurance payers, utilizing various communication methods such as paper forms, fax, payer portals, and printed documents. The incumbent will monitor requests to ensure timely approvals and escalate issues to achieve resolutions. Regular interaction with patients, insurance providers, physician offices, sales representatives, and other relevant personnel is vital.

Responsibilities

• Submit authorization requests to insurance payers specifically for Home Infusion Therapy.
• Manage follow-up processes for pending authorization requests to ensure prompt progress.
• Evaluate authorization outcomes, including approvals and denials, verifying correctness and initiating appeals when needed until resolution or discontinuation.
• Accurately document all communication, including calls, faxes, and emails, into CPR+ following departmental procedures.
• Keep precise records of authorization statuses within patient charts for future reference.
• Adhere strictly to confidentiality protocols consistent with HIPAA regulations.
• Maintain up-to-date knowledge regarding insurance policies, medical terminology, government rules, and relevant coding.
• Collaborate as a team player by sharing insurance updates and communications with management and colleagues.
• Perform additional responsibilities as assigned by the Intake Manager.

Qualifications

• High school diploma or equivalent is required.
• Previous experience working in medical offices involving patient interaction is necessary.
• Proficiency in Microsoft Office applications is expected.
• Strong verbal and written communication skills are essential for effective collaboration with coworkers, management, patients, and medical offices.
• Background in medical reimbursement is preferred but not mandatory.
• Experience with insurance authorization submission processes is advantageous.

Physical Requirements

The role requires frequent communication and ability to lift files, access filing cabinets, and occasionally bend or stand as duties demand.

Benefits

• Comprehensive medical, dental, and vision insurance coverage.
• 401(k) plan featuring company matching contributions.
• Generous paid time off including vacation, sick days, personal days, and holidays.
• Life insurance plans with standard coverage and optional additional benefits.
• Employee assistance program offering free counseling and coaching.
• Resources to support emotional well-being and maintain work-life balance.
• Company-paid short and long-term disability insurance with optional supplements.
• Accidental death and dismemberment insurance coverage.
• Flexible spending accounts and health savings accounts to manage healthcare costs.
• Programs to support commuter expenses.
• Volunteer opportunities and engagement initiatives.
• Employee referral bonus incentives.
• Exclusive discounts on entertainment, travel, various supplemental plans, and cellular services.

Equal Employment Opportunity

The PromptCare Companies strictly uphold equal employment opportunity policies, forbidding discrimination based on race, color, age, national origin, religion, gender, gender identity, sexual orientation, pregnancy, marital status, genetics, disability, veteran status, or other legally protected characteristics at state, federal, or local levels. The company values diversity, inclusion, merit-based advancement, and respectful treatment of all employees.