Prior Authorization Specialist

3 weeks ago

Brea, United States Infusion4Health Inc Full time

Infusion for Health is a referral-based infusion center that services all providers in multiple locations in California, Arizona, Nevada, Washington, Colorado, and Missouri. Our center is unique and offers individual comfortable private rooms for our patients. Our mission is to provide exceptional service in the administration of infusion therapy in a comfortable, patient-focused environment by providing exemplary professional clinical care.

Our company is continuing to grow and we're looking to add a Prior Authorization Specialist to support our patient care operations department.

This is a full-time, 5 days a week position, onsite at our Brea HQ office.

**Key Responsibilities**:

- Receive requests for prior authorizations and ensure that they are properly and closely monitored within company-set standards
- Review the accuracy and completeness of the information requested and ensure that all supporting documents are present
- Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
- Collaborate with other departments to assist in obtaining prior authorizations/appeals
- Document all interactions with insurance companies within the company system
- Document all prior authorization information, including approval dates, billing units, procedure codes, and prior authorization number in the patient profile
- Proactively work on prior authorizations that are due to be expired
- Secure patients’ demographics and medical information by using discretion and ensuring that all procedures are in sync with HIPAA compliance and regulation
- Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards
- Completes all required duties, projects, and reports in a timely fashion on a daily, weekly, or monthly basis per the direction of the leadership.
- Other duties as assigned

**Education and/or Experience Needed**:

- At least 2 years experience in infusion or pharmacy prior authorization is required
- Ability to effectively handle multiple priorities within a changing environment, emphasizing paperless workflow
- Experience in diagnosing, isolating, and resolving complex issues and recommending and implementing strategies to resolve problems.
- Intermediate level skills in Microsoft Excel & Word

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