Authorization Specialist

Vital Care Infusion Services•Phoenix, AZ

About The Position

The Authorization Specialist performs duties to initiate authorizations, with a focus on accuracy, timeliness, and adherence to processes that reduce denials, days sales outstanding (DSO), and bad debt. The role minimizes turnaround time and errors to improve collection rates while working within standard or accepted practices, including credentialing and re-credentialing and contract applications. Vital Care is a pharmacy franchise business serving patients with chronic and acute conditions through locally owned infusion pharmacies and clinics. The company has more than 100 franchised locations in 35 states and focuses on underserved and secondary markets.

Requirements

Two years of experience in intake/authorizations and home infusion therapy.
High school diploma or equivalent.
Excellent English communication skills, including listening, speaking, understanding, and writing, with the ability to influence patients, caregivers, and payer representatives, answer questions, and advance reimbursement and collection efforts.
Understanding of processes, systems, and techniques for successful billing and collection efforts across payer types.
Ability to identify documentation gaps and problems, determine lasting solutions, make effective decisions, and take corrective action.
Strong organizational skills and ability to track and maintain clear, complete records of activities, cases, and related documentation.
Knowledge and skill in using the MS Office suite and pharmacy applications.

Responsibilities

Review patient files for completeness and accuracy, identify all revenue opportunities, and complete and submit prior authorizations promptly for payer reimbursement.
Communicate authorization status effectively with franchise partners, payers, and other VCI departments.
Document case activity, communications, and correspondence in the computer system; maintain accurate account records and schedule follow-ups at required intervals.
Investigate and verify benefits for pharmacy and medical third-party claims.
Obtain reauthorizations by initiating requests, supplying additional required information, following up, tracking progress, expediting responses from insurance carriers and other payers, and keeping customers informed.
Track, report, and escalate authorization service issues or other issues that delay service, helping ensure patient access and avoid interruptions in therapy.
Communicate patients' financial obligations so they understand therapy costs before starting service.
Perform other related duties as assigned.