Infusion Insurance and Prior Authorization Coordinator

The Infusion Insurance and Prior Authorization Coordinator will independently manage and strategically evaluate patient referrals for infusion services to determine insurance and prior authorization criteria. This position serves as a subject matter expert and uses independent discretion and judgement in interpreting payer policies, medical necessity criteria, and reimbursement requirements.

Requirements

• High school diploma or GED
• Critical thinking and decisive judgment on authorization matters with financial and operational significance
• Excellent communication, organizational, and customer service skills and ability to work independently
• Knowledge of major medical insurances and proficiency with payer portals and authorization tracking tools
• Knowledge of HCPCS (J-codes) and ICD-10 (diagnosis codes) as they relate to medical and pharmacy benefits for infusion drugs
• Familiarity with medical documentation such as H&Ps, diagnostic imaging, genetic testing, oncology staging
• Ability to read and convert a prescription into an authorization request based on payer requirements
• Ability to interpret medical policies, medical necessity standards, and reimbursement methodologies
• Ability to influence outcomes through judgement, escalation, and problem solving

Benefits

• Paid time off
• 401k Matching
• Medical, dental, and vision coverage
• Tuition reimbursement