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Authorization Specialist I

2 months ago

Murfreesboro, Tennessee, United States TwelveStone Health Partners Full time
Job Title: Authorization Specialist I

TwelveStone Health Partners is a leading healthcare organization dedicated to delivering high-quality care to patients with complex and rare conditions.

We are seeking a highly skilled Authorization Specialist I to join our team at our corporate office in Murfreesboro, TN.

Job Summary:

The successful candidate will be responsible for obtaining prior authorizations for referrals for our infusion centers. This involves initializing prior medical/pharmacy authorization requests, communicating with insurance companies, and obtaining clinical information necessary to complete the prior authorization process.

Key Responsibilities:
  • Initialize prior medical/pharmacy authorization requests and submit requests in accordance with our Prior Authorization Criteria.
  • Communicate with insurance companies to pre-certify/authorize medications.
  • Obtain clinical information necessary to complete the prior authorization process, including medical history, diagnosis, and lab reports.
  • Assist with denied claims to resolve potential mistakes by providing clinical information and/or coordinating with other departments.
  • Perform duties and job functions in accordance with our policies and procedures.
Requirements:
  • High school diploma or GED required.
  • One year related experience and/or training with a healthcare organization, retail, or mail order pharmacy, or PBM.
  • Experience with completing referrals and navigating insurance portals and orders.
  • Ability to prioritize and multi-task when presented with multiple duties.
What We Offer:

TwelveStone Health Partners offers a dynamic and supportive work environment, competitive compensation, and opportunities for professional growth and development.