Authorization Specialist - Revenue Cycle Management

Vital Care Infusion Services•Pittsburgh, PA

4h•Remote

About The Position

Vital Care is recognized as a “Best Place to Work Modern Healthcare” and is committed to creating an inclusive, growth-focused environment. Vital Care is the premier pharmacy franchise business, serving patients with chronic and acute conditions through locally-owned franchise locations across the United States since 1986. With over 100 franchised Infusion pharmacies and clinics in 35 states, the company focuses on underserved and secondary markets, guiding owners through launch, growth, and successful business operations. The Authorization Specialist performs duties to initiate authorizations, focusing on accuracy, timeliness, and adherence to processes to reduce denial rates, Days Sales Outstanding (DSO), and bad debt. The role aims to minimize turnaround time and errors to improve collection rates while working within the limits of standard or accepted practice, credentialing/re-credentialing, and Contract applications.

Requirements

Excellent communication skills: listening, speaking, understanding, and writing English while influencing patients, caregivers, and payer representatives, answering questions, and advancing reimbursement and collection efforts.
Proven understanding of processes, systems, and techniques to ensure successful billing and collection efforts collaborating with all payer types.
Proven ability to identify gaps and problems from a documentation review, determine lasting solutions, make effective decisions, and take necessary corrective action.
Strong organizational skills with the ability to track and maintain clear, complete records of activities, cases, and related documentation.
Proven knowledge and skill in utilizing the MS Office suite of software and pharmacy applications.
Two years’ experience in intake/authorizations and home infusion therapy is required.
High school diploma or equivalent.

Responsibilities

Review patient files for completeness and accuracy, ensure all revenue opportunities are included to complete and submit prior authorizations timely for payer reimbursement.
Communicate effectively with franchise partners, payers, and other VCI departments regarding the status of authorizations.
Document case activity, communications, and correspondence in the computer system to ensure completeness and accuracy of account activity and actions taken to resolve outstanding authorization issues. Schedule follow-ups in required intervals.
Investigate and verify benefits for pharmacy and medical third-party claims.
Obtain reauthorizations; initiate requests, follow up to provide the additional required information, track progress, expedite responses from insurance carriers and other payers, and maintain contact with customers to keep them continuously informed.
Track, report, and escalate service issues arising from requests for authorizations or other issues that delay service to ensure patient access and to avoid delays that may interrupt therapy.
Communicate financial obligation information with patients so that they clearly understand all therapy costs before starting service.
Perform other related duties as assigned.

Benefits

Comprehensive medical, dental, and vision plans, plus flexible spending, and health savings accounts.
Paid time off, personal days, and company-paid holidays.
Paid Paternal Leave.
Volunteerism Days off.
Income protection programs include company-sponsored basic life insurance and long-term disability insurance, as well as employee-paid voluntary life, accident, critical illness, and short-term disability insurance.
401(k) matching and tuition reimbursement.
Employee assistance programs include mental health, financial and legal.
Rewards programs offered by our medical carrier.
Professional development and growth opportunities.
Employee Referral Program.