Authorization Representative
KabaFusion•Edison, NJ
•$22 - $28
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 supports revenue integrity, clean claims, and compliance while coordinating with patients, payers, and internal teams in alignment with organizational goals.
Requirements
- High school diploma or equivalent education.
- Minimum of 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 and demonstrate 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, and/or electronic healthcare record software.
Responsibilities
- Provide courteous and professional telephone support to patients, families, referral sources, payors, and clinical staff.
- Verify insurance coverage before deliveries, confirm that coverage is active and accurate, and notify internal departments and patients of policy changes or benefit terminations.
- Confirm that planned services are eligible and covered under patients’ 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 mail.
- 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 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 using insurance verification information, payer contracts, and self-pay policies.
- Coordinate and document patient start-of-care materials, creating additional documentation promptly as needed to support compliant service delivery.
- Maintain complete and accurate documentation of eligibility, authorization, and communications in the electronic medical record.
- Assist with 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 a manager or designee.
Benefits
- Competitive compensation.
- Benefits begin 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.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
