Authorization Representative

KabaFusion • Albany, NY

9d • $22 - $30

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 support of the organization's mission and operational goals.

Requirements

• High school diploma or equivalent.
• 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 work with 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, and/or 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 that coverage is active and accurate, and notify internal departments and patients about policy changes or benefit terminations.
• Determine whether 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 expiration dates and secure authorizations for ongoing care to prevent missed medication administration.
• Notify internal stakeholders, prescribers, and patients about authorization approvals, issues, and care delays.
• Estimate patient financial responsibility using insurance verification information, payer contracts, and self-pay policies.
• Coordinate and document patient start-of-care materials, preparing additional documentation promptly as needed to support compliant service delivery.
• Maintain complete and accurate electronic medical record documentation of eligibility, authorizations, and communications.
• Assist in analyzing and resolving insurance claim rejections to support timely and accurate reimbursement.
• Protect patient health information by following HIPAA regulations.
• Perform other related duties as assigned by the manager or designee.

Benefits

• Competitive compensation.
• Benefits start on the first day of employment.
• 401(k) with a 4% match and no waiting or vesting period.
• PTO, floating holidays, and paid holidays.
• Company-paid life insurance and short-term disability.
• Employee assistance programs for mental health and wellness.
• Learning and development programs.
• Discounts on travel, cell phones, clothing, and more.
• Employee referral program.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED