Role Description The Insurance Authorization Specialist plays a critical role in supporting patients, providers, and pharmacy clinicians by ensuring accurate insurance verification, authorization, and reimbursement for infusion and enteral services. This role partners closely with internal teams and external payers to streamline the referral and authorization process and minimize patient financial impact.

• Verify insurance coverage and obtain patient demographic and payer information to ensure accurate billing and claims processing.
• Secure prior authorizations for pharmacy services and follow up with referral sources, providers, patients, and payers as needed.
• Apply payer guidelines and coverage criteria to support approval of infusion and enteral therapies.
• Collaborate with clinical teams and referral sources to gather required documentation and physician orders.
• Identify potential patient out-of-pocket costs and partner with payers to determine payment solutions.
• Register patients and maintain accurate, up-to-date insurance and demographic records.
• Review therapy orders and generate required documentation, including Assignment of Benefits and Advanced Beneficiary Notices (ABNs).
• Educate patients, staff, and providers on insurance requirements, authorization processes, and coverage guidelines.
• Partner with case management and revenue cycle teams to ensure timely and accurate reimbursement.
• Maintain current knowledge of Medicare, Medicaid, and commercial payer requirements, including pre-authorization rules.

Qualifications

• High School Diploma or GED.
• 5+ years of experience in home infusion, healthcare billing, accounts receivable, or insurance authorization.
• Strong knowledge of third-party payer requirements, including authorizations, referrals, and pre-certification processes.
• Understanding of medical terminology and healthcare workflows.

Requirements

• Strong analytical, organizational, and prioritization skills.
• High attention to detail with ability to manage multiple tasks simultaneously.
• Ability to work independently with minimal supervision.
• Excellent communication and interpersonal skills; able to navigate sensitive financial discussions with patients.
• Strong computer skills, including Microsoft Office and electronic medical record (EMR) systems.

Benefits

• Paid Time Off programs.
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability.
• Flexible Spending Accounts for eligible health care and dependent care expenses.
• Family benefits such as adoption assistance and paid parental leave.
• Defined contribution retirement plans with employer match and other financial wellness programs.
• Educational Assistance Program.