Authorization Specialist

The position will entail the submission of Initial authorization requests to assigned payers. Submission of requests will be completed using paper forms, printed documentation, fax, payer portals or other means. Complete follow up on requests to ensure timely turnaround and approval. Understand payer requirements to ensure approval is granted. Escalate problem accounts and ensure resolution. Regular contact with patients, insurance plans, physician offices, sales representatives and other personnel as necessary. 

Job Status: Full-time

Job Location: 

• High School Diploma or equivalent. 
• Experience in medical office, patient contact and related experience. 
• Microsoft Office Suite experience.  
• Excellent oral and written communication skills are required to communicate with colleagues, management, patients, and physician offices. 
• Medical Reimbursement background is preferred. 
• Experience with authorization submission.  

Job Responsibilities, included but not limited to:

• Submission of authorization requests to insurance payers for Home Infusion Therapy. 
• Oversight of the completion of follow-up on pending authorizations. 
• Review authorization approvals and denials for accuracy and initiate appeal process until the case is overturned, appeal options are exhausted, or a decision is made to discontinue the process. 
• Documents details of all calls, faxed, and email communications in CPR+ per SOP of the department. 
• Maintains documented record of approved/denied authorizations in the patients’ chart for reference. 
• Maintains strict confidentiality and adhere to HIPPA guidelines and regulations. 
• Maintains a broad range of knowledge of insurance plan requirements, medical terminology, government regulation, and codes. 
• Work as a team player and shares knowledge gained per insurance updates and communications with management and team members.  
• Other duties as assigned by Intake Manager.  

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and listen. Requires the ability to lift files, open filing cabinets and bend or stand as necessary. 

Benefits & Perks

• Comprehensive Medical, Dental, and Vision Package
• 401(k) Plan with Company Match
• Generous PTO: Vacation, Sick Time, Personal Days, and Paid Holidays
• Life Insurance: Standard coverage with optional enhancements
• Employee Assistance Program: Free counseling and coaching sessions
• Emotional Well-being and Work-Life Balance Resources
• Short & Long-Term Disability: Company-paid with optional supplements
• Accidental Death and Dismemberment Insurance
• FSA and HSA: Manage healthcare expenses
• Commuter Spending Programs
• Volunteer and Engagement Opportunities
• Employee Referral Bonuses
• Exclusive Discounts on entertainment, travel, and various other supplemental and cellphone plans

Equal Employment Opportunity

The PromptCare Companies is committed to Equal Employment Opportunity (EEO) and prohibits employment discrimination on the basis of race, color, age, national origin, religion, gender, gender identity, sexual orientation, pregnancy, marital status, genetic disposition, disability, veteran's status or any other characteristic or classification protected by State/Federal/Local laws. We foster a work environment in which diversity and inclusion are embraced, people are hired and advanced on their merits, and employees are treated with mutual respect and dignity.