Insurance Authorization Specialist: Infusion Therapy/Biologics

$45,000 - $60,000/Yr

Thrivewell Infusion - Riverhead, NY

Full-time - Entry Level

Remote - Riverhead, NY

Ambulatory Health Care Services

About the position

The Insurance Authorization Specialist at Thrivewell Infusion is responsible for obtaining prior authorizations from insurance companies for medications used in infusion therapy for patients with complex chronic and rare diseases. This role is critical in ensuring that patients have access to necessary medications while maintaining continuity of care throughout their treatment cycles. The position requires collaboration with various departments and a strong understanding of insurance policies and guidelines.

Responsibilities

• Prepare and submit prior authorization requests to insurance companies, ensuring accuracy and completeness of documentation.
• Collaborate with various departments to ensure necessary clinical information is obtained for prior authorization requests.
• Review insurance policies and guidelines to determine the requirements for obtaining prior authorizations and ensure continuity of authorizations across the treatment timeframe.
• Review medical information and identify necessary documents for approval across various insurance payers.
• Follow up on prior authorization requests, including denials and appeals, when necessary, to ensure timely approval of medications.
• Maintain accurate records of prior authorization requests and approvals in EMR and support software.
• Assist medication procurement team by receiving and logging deliveries of treatments.

Requirements

• Bachelor's degree (preferred) or a minimum of 3 years of experience working in healthcare, with a focus on prior authorizations for high-value medications for rare chronic diseases.
• Previous experience in healthcare administration, authorization coordination, or related field required.
• Strong knowledge of insurance policies and guidelines related to prior authorizations.
• Excellent communication and interpersonal skills, with the ability to effectively advocate for patients with insurance companies.
• Proficiency in computer applications, including medical management systems and Microsoft Office suite.
• Ability to work effectively both independently and as part of a team in a fast-paced environment.
• Detail-oriented and organized, with the ability to manage multiple tasks and priorities simultaneously.
• Proficiency in using EMR systems and other relevant software applications.

Nice-to-haves

• Knowledge on specialty medication procurement vs buy and bill model.

Benefits

• Competitive salary based on experience.
• Comprehensive benefits package, including healthcare coverage, retirement plans, and paid time off.
• Opportunities for professional development and advancement within the company.
• A supportive and collaborative work environment dedicated to providing exceptional patient care.