Q
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Recruiter Details
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HR Specialty Infusion
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operluk@specialtyinfusion.com
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2127769090
Prior Authorization Specialist
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By Specialty Infusion Posted On 01/27/2020
- Job expire date: 12/31/2020
- Available After: Immediate
- Job Type: Permanent
- Hourly Rate: USD 22 - 28 / Hour
- 475, Park Avenue South, Manhattan, New York County, New York, United States
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Functional Area: Pharma / Biotech / Healthcare / Medical / R&D
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Industry: Medical/Healthcare/Hospital
Job Description:
Founded in 2017, Specialty Infusion has established 6 outpatient infusion centers in the Northeast region with plans of expanding into 10 additional sites in new territories. We offer state-of-the-art ambulatory infusion centers in an alternative site of care from the traditional hospital-based treatment.
As part of a larger multi-divisional healthcare company founded 19 years ago, Specialty Infusion also proudly works alongside our specialty pharmacies and urgent care centers.
www.specialtyinfusion.com
Responsibilities:
- Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt
- Documents specific details related to the authorization including approval number, valid dates, and number of visits using the appropriate system
- Responsible for verification and investigation of pre-certification, authorization, and pre-determination requirements for services
- Successfully works with payers via electronic/telephonic and/or fax communications
- Coordinates and supplies information to the review organization (payer) including medical information and/or letter of medical necessity for determination of benefits
- Collaborates with designated clinical contacts regarding encounters that require escalation to peer-to-peer review
- Appropriately prioritizes workload to ensure the most urgent cases are handled in a timely manner; completes accurate documentation regarding the process
- Ensures timely and accurate insurance authorization is in place prior to services being provided
- Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
- Collaborate with other departments to assist in obtaining pre-authorizations in a cross-functional manner
- Communicates with patients, clinical partners, financial counselors, and others as necessary to facilitate the authorization process
- Review the accuracy and completeness of the information requested for prior authorizations and ensure that all supporting documents are present
- Receive requests for prior-authorizations and ensure that they are properly and closely monitored
- Process and submit medical records to insurance carriers to expedite prior authorization processes
- Manage correspondence with insurance companies, internal staff, and specialists as required
- Look through denials and submit appeals in a bid to get them approved from insurance companies
- Secure patients’ demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPAA compliance and regulation
Requirements:
- BA/BS degree required
- Proficient Microsoft Word, Excel, and other office products required
- Knowledge of health care and medical terminology required
- Excellent customer services skills, ability to independently problem-solve, and perform basic mathematical calculation
- Must have 4+ years experience working in a Healthcare setting
What we offer:
- Competitive Salary & Sales Commission
- Supportive Team
- Career Growth
- Commuter Benefits
- Flexible Work Schedule
- Paid Vacation, Holidays and Personal Time
- Medical, Dental and Vision Insurance
- 401K Retirement Plan
About Company
- Specialty Infusion is an alternative site of care infusion treatment solution. We offer a low-cost alternative to receiving infusion treatments in a hospital or through a home infusion provider while providing top-quality medical care and amenities to ensure the comfort of our patients.