Authorization Representative

KabaFusion•Carrollton, TX

About The Position

The Authorization Representative ensures patients can continue care without delay by securing accurate insurance verification, required authorizations, and complete start-of-care documentation. The role protects revenue integrity, supports clean claims, and ensures compliance while coordinating with patients, payers, and internal teams in alignment with organizational goals. The position provides professional telephone support, verifies insurance coverage and benefit eligibility, tracks and secures authorizations, documents patient financial obligations and start-of-care materials, estimates patient financial responsibility, and assists with insurance claim rejections. It also maintains complete and accurate records in the electronic medical record and follows HIPAA requirements.

Requirements

High school diploma or equivalent education.
At least two years of experience in home infusion or a fast-paced healthcare environment.
Knowledge of HCPCS/CPT codes, authorization submission processes, and insurance coverage requirements, including Medicare, Medicaid, and commercial plans.
Familiarity with medical terminology and billing pricing methodologies.
Strong problem-solving skills, including the ability to research, analyze, and resolve issues independently with initiative and sound judgment.
Ability to learn and use internal billing, authorization, and patient management platforms.
Ability to work independently with minimal supervision, prioritize and multitask, meet goals and deadlines, and collaborate with cross-functional teams.
Accuracy in calculating pricing quotes and authorization lengths using approved units and days.
Effective communication skills when interacting with patients, clinical teams, and corporate departments.

Nice To Haves

Proficiency with Microsoft Office, including Word, Excel, and Teams.
Experience with electronic healthcare record software.

Responsibilities

Provide courteous and professional telephone support to patients, families, referral sources, payers, and clinical staff.
Verify insurance coverage before deliveries, confirm active coverage and accuracy, and notify internal departments and patients of policy changes or benefit terminations.
Ensure proposed services are eligible and covered under the patient's insurance benefits.
Complete start-of-care, Financial Obligation, and Medicare/Medicaid forms accurately and promptly, and distribute them to Pharmacy and Nursing Departments electronically or by postal delivery.
Collect, verify, and document insurance cost-share and authorization details, including coinsurance, copays, deductibles, and requirements.
Track authorization needs and expirations and secure authorizations for ongoing patient care to prevent missed medication administration.
Notify internal stakeholders, prescribers, and patients promptly about authorization approvals, issues, or delays in care.
Estimate patient financial responsibility accurately using insurance verification information, payer contracts, and self-pay policies.
Coordinate and document patient start-of-care materials and prepare additional documentation promptly as needed to support compliant service delivery.
Maintain complete and accurate documentation of eligibility, authorizations, and communications in the electronic medical record.
Assist in analyzing and resolving insurance claim rejections to support timely and accurate reimbursement.
Protect patient health information by complying with HIPAA regulations.
Perform other related duties as assigned by the manager or designee.