Authorization Coordinator

JOB TITLE: Authorization Coordinator

EMPLOYER: Twelfth One, LLC dba Aspen Infusion

DEPARTMENT: Intake

REPORTS TO: Insurance Authorization Manager

SUMMARY: Review home infusion orders and the associated medical documentation to ensure accuracy before submitting authorization requests. Perform the necessary authorization submissions for initial referrals, modifications to orders, insurance changes, and ongoing long-term therapies. Ensure that all completed tasks are documented clearly and accurately.

DUTIES AND RESPONSIBILITIES:

• Report any misconduct, suspicious, or unethical activities to the Compliance Officer
• Verify insurance eligibility and benefits
• Obtain referrals and complete required notifications and payor forms
• Submit pharmacy and medical insurance pre-authorizations via fax, payer portal, or telephone
• Process authorization requests for: New referrals, Order changes, Insurance updates, Ongoing long-term therapies
• Coordinate with internal teams, providers, and external customers to obtain additional information for authorization requests
• Track and follow up on all appeal and authorization submissions according to departmental policy and insurance payer requirements
• Communicate approvals, denials, appeal options, and ongoing status to pharmacy staff, billing, healthcare team, customers, and supervisors
• Review home infusion orders and medical documentation for accuracy
• Handle incoming and outgoing calls related to the authorization/appeal process
• Collaborate with providers and internal teams to address denials or gather alternative documentation
• Report recurring payer issues, trends, or changes to the supervisor
• Cross-train within the department to ensure smooth workflow and coverage
• Ensure all tasks are performed accurately, efficiently, and within required timeframes to meet departmental and insurance guidelines
• Maintain HIPAA compliance and participate in ongoing training as required
• Understand and comply with all applicable company policies and procedures
• Perform other duties as directed by management

SUPERVISORY RESPONSIBILITIES:

• This job has no supervisory responsibilities.

QUALIFICATIONS:

• High school diploma or general education degree (GED)
• Minimum of 1 year of related experience in medical insurance authorization and/or training
• Proficiency in basic math skills is required for this position
• Computer skills required: Google software (Docs; Drive; Sheets) 
• Experience in home infusion pharmacy preferred, not required

COMPETENCIES:

• Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.
• Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
• Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
• Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
• Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
• Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.

PHYSICAL DEMANDS AND WORK ENVIRONMENT:

• Continually required to stand, walk, sit, talk and hear
• Continually required to utilize hand and finger dexterity
• The employee must occasionally lift and/or move up to 30 pounds 
• Specific vision abilities required by this job include: Close vision; Distance vision; Color vision; Peripheral vision; Depth perception and ability to adjust focus

The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities, or physical requirements. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. We reserve the right to revise job duties. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.