Case Management, Compensation and Benefits, Computer Vision, Data Quality, Dental Insurance, Electronic Medical Records, Employee Assistance Plan, FDA (Food and Drug Administration), Health Insurance, Health Plan, Healthcare, Insurance, Insurance Documentation, Intravenous Therapies, Lift/Move 25 Pounds, Medical Office, Medications, Microsoft Excel, Microsoft Office, Microsoft Outlook, Microsoft Word, Nursing Management, On Call, Onboarding, Organizational Skills, Patient Care, Patient Care Authorizations, Quality of Care, Reimbursement, Standards Development, Team Player, Time Management, Vision Plan
Prior Authorization Specialist / Insurance Verification Coordinator
Job Details
- Pay: $23.00 - $26.00 an hour
- Job Type: Full-time
- Schedule: Monday to Friday, 8:00 AM – 5:00 PM (No weekends)
- Benefits: Medical, Dental, Vision, 401(k), PTO, Tuition Assistance (Full Benefits Package)
About Us
We provide comprehensive ambulatory and home-based infusion services to both acute and chronically ill patients. Our centers care for people by providing patients and their families with a convenient, affordable, and safe place to receive infusion treatments.
We believe in creating a healthcare experience that goes beyond just a job. We are a connected group of caretakers who work together to restore health and hope to our patients. For our employees, this means a culture of belonging, mutual respect, empathy, and continuous collaboration.
Role Overview (As a Patient Access Navigator)
We are seeking an Insurance Case Manager / Prior Authorization Specialist to function as a vital bridge between our clinical team, intake coordinators, and insurance payers. In this role, you aren't just processing paperwork—you are a Patient Access Navigator, ensuring patients get timely access to life-changing infusion therapies by accurately verifying health benefits and securing critical authorizations.
What You'll Do (Essential Functions)
- Verify Benefits: Utilize web portals and phone outreach to verify comprehensive insurance benefits.
- Secure Authorizations: Review payer medical policies to determine medical necessity based on guidelines and FDA indications; manage the prior authorization and reauthorization process.
- Ensure Data Integrity: Obtain and review patient data, signed written orders (SWO), and letters of medical necessity (LMN) from referring physician offices.
- Collaborate: Partner closely with Intake Coordinators, Nurse Managers, and the Reimbursement team to ensure smooth patient onboarding and high operational standards.
- Communicate & Document: Complete insurance verification forms, scan documents into electronic medical records, and provide clear coverage summaries to the team.
- Financial Coordination: Coordinate first payments and payment plans for patients when necessary.
- Support: Participate in an on-call rotation for after-hours and holidays as needed.
Qualifications & Skills
- Education: High School Diploma or Equivalent (Required).
- Experience: 1+ years of experience managing health insurance benefit verifications and prior authorizations (Required). Specialty medication or infusion experience is a plus.
- Software: Proficiency in MS Office (Outlook, Word, Excel) and electronic medical records.
- Attributes: Ability to stay calm, organized, and focused in an ambiguous, fast-paced environment. Strong teamwork and relationship-building skills.
Full Benefits Package
- Comprehensive Medical, Dental, and Vision Insurance
- Company-Paid Life Insurance + Voluntary Life & Disability
- Flexible Spending Accounts (FSA) & Health Savings Account (HSA)
- 401(k) Retirement Plan
- Paid Time Off (PTO) + 8 Paid Company Holidays
- Tuition Assistance & Employee Referral Program
- Employee Assistance Program (EAP) & Employee Discounts
- Ramsey SmartDollar Financial Wellness Program
Physical Demands
- Prolonged periods of sitting, reading, and keyboarding/computer vision.
- Frequent standing, walking, bending, twisting, talking, and hearing.
- Occasionally lifting and/or moving up to 25 pounds.
Our Commitment to Patient Advocacy
At our core, we believe that patient advocacy is at the heart of everything we do, regardless of our roles within the organization. Each member of our team is dedicated to putting the needs and well-being of our patients first. Whether we're working directly with patients or supporting them behind the scenes, our commitment to being a compassionate advocate is paramount.
We understand that every interaction, every decision, and every effort contributes to the quality of care our patients receive. Together, we strive to ensure that every individual feels heard, supported, and empowered throughout their healthcare journey. This dedication to patient-centered care is what creates our standard of excellence that defines us and enriches the lives of those we serve.
Apply Today
Take the next step in your healthcare career and join a team dedicated to delivering exceptional infusion care!
To apply or for immediate consideration, please contact Brian Harris Email: Brian@prosperityplacement.com Phone: 941-999-4291