Authorization Representative

About the role

KabaFusion is a leading home infusion company with a strong focus on patient care and a diverse workforce. Founded in 2010, the company has expanded to become the largest privately held home infusion company in the country, serving over 40 states with a national network of pharmacies and nursing offices.

Responsibilities

• Provides courteous and professional telephone support to patients, families, referral sources, payors, and clinical staff.
• Verifies insurance coverage prior to deliveries to ensure accuracy, active coverage, and notifies internal departments and patients of any policy changes or benefit terminations.
• Ensures services to be provided are eligible and covered under the patient’s insurance benefits.
• Accurately estimates patient financial responsibility by applying insurance verification information, payer contracts, and self-pay policies.
• Coordinates and documents patient start-of-care materials, creating additional documentation on a timely basis as needed to support compliant service delivery.
• Ensures complete and accurate documentation of eligibility, authorization, and communications within the electronic medical record.
• Assists with analyzing and resolving insurance claim rejections to support timely and accurate reimbursement.
• Protects patient health information by following regulations for HIPAA compliance.

Qualifications

• High school diploma or equivalent education.
• Minimum of two (2) years in home infusion or fast-paced health care environment.
• Proficient experience with Microsoft Office including Word, Excel, and Teams, and/or electronic health care record software system preferred.

Skills and Competencies

• Knowledge of HCPCS/CPT codes, authorization submission processes, and insurance coverage requirements, including Medicare, Medicaid, and commercial plans, with familiarity in medical terminology and billing pricing methodologies.
• Strong problem-solving skills with the ability to proactively research, analyze, and resolve issues independently, demonstrating initiative and sound judgment.
• Proficiency in learning and working with internal company platforms, including billing, authorization, and patient management systems.
• Ability to work independently with minimal supervision while effectively prioritizing, multitasking, and meeting goals and deadlines, as well as collaborating successfully with cross-functional teams.
• Demonstrated accuracy in calculating pricing quotes and authorization lengths using approved units and days, coupled with effective communication skills when interacting with patients, clinical teams, and corporate departments.

What We Offer

• Competitive compensation.
• Benefits start on your 1st day of employment, including a 401k with a 4% match (no waiting or vesting period).
• PTO / Floating Holidays / Paid Holidays.
• Company-paid life insurance, short-term disability.
• Employee Assistance programs to help with mental health/wellness.
• Learning & Development Programs.
• Generous employee referral program.

To learn more about KabaFusion, please visit our careers page: https://www.kabafusion.com/careers/