Authorization Specialist

Vital Care Infusion Services•Tucson, AZ

About The Position

The Authorization Specialist performs duties to initiate and manage authorizations, emphasizing accuracy, timeliness, and adherence to established processes to reduce denials, days sales outstanding, and bad debt. The role minimizes turnaround time and errors to improve collection rates while working within standard or accepted practices, credentialing and re-credentialing, and contract applications. The position reviews patient files, verifies benefits, obtains authorizations and reauthorizations, follows up with payers, documents case activity, and communicates with franchise partners, patients, payers, and internal departments to support reimbursement and uninterrupted access to therapy.

Requirements

Two years of experience in intake/authorizations and home infusion therapy.
High school diploma or equivalent.
Excellent English listening, speaking, comprehension, and writing skills, including 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 Microsoft Office software and pharmacy applications.

Responsibilities

Review patient files for completeness and accuracy, identify all revenue opportunities, and complete and submit prior authorizations on time 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 to maintain complete and accurate account records and record actions taken to resolve authorization issues.
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 authorization service issues or other issues that delay service, supporting patient access and preventing interruptions to therapy.
Communicate patients’ financial obligations so they understand therapy costs before starting service.
Perform other related duties as assigned.