Prior Authorization Specialist

The Authorization Coordinator is responsible for securing insurance pre-certifications and authorizations before scheduled Infusion Center treatments. This on-site role involves direct communication with patients, staff, and providers. Key duties include pre-registering patients in Meditech, verifying insurance, obtaining authorizations, and serving as the primary liaison between the Infusion Center, referring providers, insurance carriers, and patients. Strong computer, organizational, and communication skills are required, along with at least 2 years of CPT/HCPCS and ICD-10 coding experience.

Major Responsibilities:

1. Review physician orders for medical necessity and insurance requirements for authorization.
2. Pre-register patients, verify insurance, and obtain necessary authorizations for scheduled/urgent infusions.
3. Communicate with Infusion Center and pharmacy staff to track drugs supplied by specialty pharmacies.
4. Update Infusion Center and patient access staff on pending authorizations and reschedule/cancel if needed.
5. Monitor changes to treatment orders or appointment dates and update authorizations as needed.
6. Act as a liaison with providers and patients on insurance authorization status and requests for documentation.
7. Coordinate peer-to-peer reviews with payers and providers when necessary.
8. Contribute to ongoing improvements in insurance verification, pre-registration, and authorization processes.
9. Interact with patients and staff to ensure accuracy of demographic, billing, and clinical data.
10. Participate in staff meetings, educational opportunities, and maintain professional relationships across departments.
11. Maintain patient confidentiality and privacy in all interactions.