Authorization Representative

KabaFusion•Chicago, IL

8d•$26 - $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 helps protect revenue integrity, support clean claims, and ensure compliance while coordinating with patients, payers, and internal teams in alignment with organizational goals. The position provides telephone support; verifies insurance coverage and benefit eligibility; gathers and documents cost-share and authorization details; tracks authorization requirements and expirations; and communicates approvals, issues, or delays. It also prepares and coordinates start-of-care and financial documentation, estimates patient financial responsibility, maintains complete records in the electronic medical record, and helps resolve insurance claim rejections.

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 independently resolve issues with initiative and sound judgment.
Ability to learn and use internal billing, authorization, and patient management systems.
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 and accurate coverage, and notify internal departments and patients about policy changes or benefit terminations.
Confirm that planned 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 mail.
Collect, verify, and document insurance cost-share and authorization details, including coinsurance, copays, deductibles, and requirements.
Track authorization needs and expirations and obtain 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 using insurance verification information, payer contracts, and self-pay policies.
Coordinate and document patient start-of-care materials and prepare additional documentation as needed to support compliant service delivery.
Maintain complete and accurate electronic medical record documentation of eligibility, authorizations, and communications.
Assist with analyzing and resolving insurance claim rejections to support timely and accurate reimbursement.
Protect patient health information in accordance with HIPAA requirements.
Perform other related duties as assigned by a manager or designee.