Benefits and Authorizations Specialist Lead

Responsibilities

• Verify and document insurance eligibility, benefits, and coverage for office visits and infusion services
• Obtain insurance authorization and pre-certification
• Facilitate insurance denial mitigation steps including peer-to-peer reviews and appeals
• Maintain knowledge of infusion drug authorization requirements and regulatory guidelines
• Calculate and communicate patient financial responsibility
• Provide financial assistance support by identifying patient assistance programs and manufacturer copay assistance enrollment

Requirements

• High school diploma or equivalent
• 2-3 years of experience in medical insurance verification and prior authorizations
• Knowledge of insurance terminology, plan types, and approval types
• Experience with J-codes, CPT, and ICD-10 coding
• Knowledge of medical terminology and clinical documentation review
• Strong organizational and multi-tasking skills

Preferred Qualifications

• Experience in infusion services
• Previous experience using Athena