Authorization Specialist

Vital Care Infusion Services•Houston, TX

16h

About The Position

The Authorization Specialist initiates and manages authorizations with a focus on accuracy, timeliness, and adherence to established processes. The role works to reduce denials, days sales outstanding (DSO), and bad debt; minimize turnaround time and errors; and improve collection rates. Responsibilities are performed within standard or accepted practice and include credentialing/re-credentialing and contract applications. The specialist reviews patient files, verifies benefits, submits prior authorization and reauthorization requests, follows up with payers, documents case activity, and keeps customers informed. The role also communicates patients’ financial obligations before therapy begins and escalates issues that could delay service or interrupt therapy.

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 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 Microsoft Office software and pharmacy applications.

Responsibilities

Review patient files for completeness and accuracy, identify revenue opportunities, and submit prior authorizations promptly for payer reimbursement.
Communicate authorization status with franchise partners, payers, and other Vital Care departments.
Document case activity, communications, correspondence, and actions taken to resolve outstanding authorization issues in the computer system.
Schedule follow-ups at required intervals.
Investigate and verify benefits for pharmacy and medical third-party claims.
Obtain reauthorizations by initiating requests, following up with required information, tracking progress, expediting payer responses, and keeping customers informed.
Track, report, and escalate service issues related to authorization requests or other issues that may delay service, patient access, or therapy.
Explain patients’ financial obligations so they understand therapy costs before starting service.
Perform other related duties as assigned.

Benefits

Comprehensive medical, dental, and vision plans
Flexible spending and health savings accounts
Paid time off, personal days, and company-paid holidays
Paid paternal leave
Volunteerism days off
Company-sponsored basic life insurance and long-term disability insurance
Employee-paid voluntary life, accident, critical illness, and short-term disability insurance
401(k) matching
Tuition reimbursement
Employee assistance programs for mental health, financial, and legal support
Rewards programs offered by the medical carrier
Professional development and growth opportunities
Employee referral program