Benefits and Authorizations Specialist

Job Summary: The Benefits Specialist is responsible for verifying patient insurance coverage, submitting pre-authorizations, and financial assistance support to ensure patients receive coverage for medical and infusion services provided.

Key Responsibilities:

- Verify and document insurance eligibility, benefits, and coverage for all office visits and infusion services.

- Obtains insurance authorization and pre-certification for office visits and infusion services.

- Facilitate insurance denial mitigation steps such as peer-to-peer reviews and appeals.

- Maintains a good working knowledge of infusion drug authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization.

- Calculate and communicate patient financial responsibility.

- Provide financial assistance support to patients including identifying patient assistance programs and manufacturer copay assistance enrollment.

Qualifications:

- High school diploma or equivalent

- 2-3 years of experience in medical insurance verification and prior authorizations. Experience in infusion services is preferred.

- · Knowledge of insurance terminology, plan types, structures, and approval types

- · Previous experience with J-codes, CPT and ICD-10 coding

- Previous Athena use a plus, but not a requirement

- · Knowledge of medical terminology and clinical documentation review

- Strong organizational skills

- Detail-oriented

- Ability to multi-task and work well in a fast-paced setting

- Critical thinking skills and decisive judgment