Authorization Specialist

Vital Care Infusion Services•Monroeville, PA

9h•Onsite

About The Position

Vital Care is the premier pharmacy franchise business with franchises serving a wide range of patients, including those with chronic and acute conditions. Since 1986, our passion has been improving the lives of patients and healthcare professionals through locally-owned franchise locations across the United States. We have over 100 franchised Infusion pharmacies and clinics in 35 states, focusing on the underserved and secondary markets. We know infusion services, and we guide owners along the path of launch, growth, and successful business operations. This role involves performing duties to initiate authorizations, focusing on accuracy, timeliness, and adherence to processes to reduce denial rate, DSO, and bad debt. The goal is 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.