Prior Authorization Specialist

Infinx

7d • Remote

About The Position

Under general direction, this position is responsible for obtaining pre-certifications and pre-authorizations for procedures and medications, and could include scheduling appointments for outpatient testing with other providers, coordinates patient appointments/orders.

Requirements

• High School Diploma or GED as a basic qualification
• 2 years of experience working in a physician's office, pharmacy, or healthcare facility
• 2+ years of experience reviewing and processing prior authorization requests for cardiology, oncology, or genetic testing for multiple payers (Commercial, Medicare, Medicaid, marketplace plans)
• Strong computer literacy, including 2+ years of experience with Windows 11, Microsoft Office 365, Adobe Acrobat, proper phone etiquette, EMR/EHR systems, and a 43 wpm typing speed
• Ability to read, interpret, and apply medical terminology and clinical documentation
• Strong teamwork capabilities, self-motivation, and reliability
• Ability to multitask and work effectively in a high-volume, fast-paced, and deadline-driven environment
• Strong communication skills with the ability to interact with insurance companies via phone, fax, and electronic portals
• Ability to navigate insurance phone trees with ease
• Ability to work from 8am - 5pm Central
• Strong organizational skills and attention to detail
• Ability to maintain confidentiality and follow HIPAA regulations
• Problem-solving ability to investigate denials and determine next steps
• Comfortable navigating payer websites and electronic authorization systems

Nice To Haves

• Medical Assistant certification
• 5 years processing pre-determinations and insurance verification of benefits
• 5+ years working in a doctor's office or clinic and with medical terminology, payer portals, and TPA portals
• Ability to probe insurance representatives to obtain accurate authorization information
• 5+ years reading and interpreting clinical documentation
• 5+ years processing prior authorizations for genetic and molecular lab testing or cardiology/cardiovascular procedures
• Experience in Cerner EMR

Responsibilities

• Obtain timely prior authorization or pre-determinations from all insurances, to include commercial plans, Medicaid, Medicaid and Medicare Advantage plans, following the company's established policies and protocols
• Selecting accurate and pertinent medical records from patients' charts from client's EMR
• Obtaining demographic information and verifying insurance information
• Provide all required clinical information to insurance companies necessary to facilitate the authorization process
• Perform complete documentation (within company software or client's EMR) on all prior authorizations follow-ups and determinations appropriately and in a timely manner
• Maintain and update internal listing of insurance carriers that require authorization, their processes, and phone and fax numbers
• Maintain the strictest confidentiality in accordance with HIPAA regulations and clinic requirements

Benefits

• Access to a 401(k) Retirement Savings Plan.
• Comprehensive Medical, Dental, and Vision Coverage.
• Paid Time Off.
• Paid Holidays.
• Additional benefits, including Pet Care Coverage, Employee Assistance Program (EAP), and discounted services.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED