Infusion Insurance and Prior Authorization Coordinator

Responsibilities

• Independently manage and strategically evaluate patient referrals for infusion services to determine if insurance and prior authorization criteria are met to accept or deny the patient for outpatient infusion services.
• Serve as a subject matter expert using independent discretion and judgement in interpreting payer policies, medical necessity criteria, and reimbursement requirements.
• Ensure proper and timely insurance authorization, answer infusion financial questions for patients and providers, and document authorization outcomes to guide optimal and timely infusion service management.
• Manage uninsured and underinsured patient referrals with patient assistance and charity options.
• Act as a subject matter expert and key operational resource to clinical leadership, revenue cycle leadership, and providers.

Qualifications

Required Qualifications

• High school diploma or GED.
• Critical thinking and decisive judgement on authorization matters with financial and operational significance.
• Excellent communication, organizational, and customer service skills; ability to work independently.
• Knowledge of major medical insurances and proficiency with payer portals and authorization tracking tools.
• Knowledge of HCPCS (J-codes) and ICD-10 (diagnosis codes) as they relate to medical and pharmacy benefits for infusion drugs.
• Familiarity with medical documentation such as H&Ps, diagnostic imaging, genetic testing, and oncology staging.
• Ability to read and convert a prescription into an authorization request based on payer requirements.
• Ability to interpret medical policies, medical necessity standards, and reimbursement methodologies.
• Ability to influence outcomes through judgement, escalation, and problem solving.

Preferred Qualifications

• 1-2 years progressive experience in pharmacy, medication authorizations, or revenue cycle operations involving independent decision making.
• Associate’s or Bachelor’s degree in healthcare administration, business, or related field.

Benefits

• Comprehensive benefits package with flexibility to tailor benefits to individual needs.
• Paid time off.
• 401K retirement plan.
• Medical, dental, and vision coverage.
• Tuition reimbursement.
• Additional voluntary benefit options.

Our Total Rewards package includes abundant resources, programs, and voluntary options to support individual growth and well-being.

Pay

A reasonable compensation estimate for this role is $XX.XX to $XX.XX. The exact starting compensation will be determined based on factors such as skillset, years of applicable experience, education, credentials, and licensure.

Schedule

Full Time, Day Shift.