Q
  • Recruiter Details
  • HR Specialty Infusion

  • operluk@specialtyinfusion.com

  • 2127769090

Prior Authorization Specialist

  • 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
  • Functional Area: Pharma / Biotech / Healthcare / Medical / R&D
  • 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.