You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking a Prior Authorization Specialist responsible for handling insurance verification and prior authorizations for infusion treatments. The primary goal is to ensure seamless and efficient authorization processes, supporting patient care and adherence to protocols.

Key Responsibilities

• Verify insurance eligibility and benefits for patients scheduled for infusion treatments.
• Confirm coverage details, such as co-pays, deductibles, out-of-pocket limits, and plan requirements for specialty/infusion drugs.
• Identify if prior authorization is required based on payer guidelines.
• Contact insurance companies or access online portals to confirm policy details and limitations.
• Document verified insurance details in the electronic medical record (EMR) and communicate benefit information to patients and clinical staff.
• Obtain prior authorizations for infusion services by submitting necessary documentation, including physician orders, clinical notes, and relevant codes.
• Monitor the status of submitted authorizations and perform timely follow-ups to ensure approval.
• Respond to payer requests for additional information and coordinate peer-to-peer reviews if needed.
• Manage and resolve denied authorization requests by initiating appeals and collaborating with clinical and billing teams.
• Maintain up-to-date knowledge of payer policies, drug-specific requirements, and infusion protocols.

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.