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 to efficiently manage insurance verification and prior authorization processes for infusion treatments. This role involves verifying insurance eligibility, submitting authorization requests, and ensuring timely approvals and communications with both patients and clinical staff.
Key Responsibilities
- Verify insurance eligibility and benefits for patients scheduled for infusion treatments.
- Confirm coverage details such as co-pays, deductibles, out-of-pocket maximums, and plan requirements for specialty/infusion drugs.
- Determine whether prior authorization is required based on specific payer guidelines.
- Contact insurance companies or utilize online portals to confirm policy details and coverage limitations.
- Accurately document verified insurance information in the EMR and communicate benefit details to patients and clinical staff.
- Submit prior authorization requests for infusion services, including necessary documentation such as physician orders, clinical notes, and applicable codes.
- Track and monitor authorization statuses, following up proactively to ensure timely approvals.
- Respond to payer requests for additional information and coordinate peer-to-peer reviews when necessary.
- Address and resolve denied authorizations by initiating appeals and collaborating with clinical and billing teams.
- Stay current on payer policies, drug-specific requirements, and infusion treatment protocols.
Qualifications
- EMR experience.
- At least 1 year of prior authorization experience.
- Ability to work on-site.
- Preferred qualifications include diagnostics and infusion experience.
Skills
- EMR experience.
- Proactive communication and teamwork skills.
Benefits
- Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
- Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
- 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
- Short Term Disability Insurance.
- Term Life Insurance Plan.
*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
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.
*As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
