Insurance Authorization Specialist III - Remote

Overview

The Insurance Authorization Specialist III is responsible for obtaining authorizations for elective infusions and injections, ensuring financial clearance for patients and reimbursement for the organization.

In Short

• Obtain authorizations for elective infusions and injections.
• Utilize payor resources and medical policies for verification.
• Serve as a liaison between clinical teams and pharmacists.
• Code cases and review clinical documentation for completeness.
• Manage workloads using the EPIC system.
• Communicate outpatient benefit information to Patient Financial Services.
• Research CPT codes and verify authorization requirements.
• Submit and follow up on authorization requests.
• Participate in team meetings and maintain confidentiality.
• Assist with denial management issues.

Requirements

• High school graduate or equivalent with 2 years of experience in a medical environment.
• Associate’s degree with 1 year of experience preferred.
• 3 years of knowledge in medical terminology, ICD-10, and CPT coding preferred.
• Understanding of authorization processes and third-party payors.
• Proficiency in Microsoft Office applications.
• Excellent communication and interpersonal skills.
• Ability to prioritize and multitask efficiently.
• Basic computer skills required.

Benefits

• Work in a supportive outpatient clinical environment.
• Engage in team collaboration and meetings.
• Opportunity for professional development.
• Contribute to a large health system with numerous facilities.
• Be part of a team dedicated to patient care and financial clearance.