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Prior Authorization Specialist

  • Job expire date: 12/31/2020
  • Available After: Immediate
  • Job Type: Permanent
  • Hourly Rate: USD 22 - 28 / Hour
  • 475, Park Avenue South, Manhattan, New York County, New York, United States
Functional Area Pharma / Biotech / Healthcare / Medical / R&D
Industry Medical/Healthcare/Hospital
Job Description
  • Founded in 2017, Specialty Infusion has established 6 outpatient infusion centers in the Northeast region with plans of expanding into 10 additional sites in new territories. We offer state-of-the-art ambulatory infusion centers in an alternative site of care from the traditional hospital-based treatment.

    As part of a larger multi-divisional healthcare company founded 19 years ago, Specialty Infusion also proudly works alongside our specialty pharmacies and urgent care centers.


    • Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt
    • Documents specific details related to the authorization including approval number, valid dates, and number of visits using the appropriate system
    • Responsible for verification and investigation of pre-certification, authorization, and pre-determination requirements for services
    • Successfully works with payers via electronic/telephonic and/or fax communications
    • Coordinates and supplies information to the review organization (payer) including medical information and/or letter of medical necessity for determination of benefits
    • Collaborates with designated clinical contacts regarding encounters that require escalation to peer-to-peer review
    • Appropriately prioritizes workload to ensure the most urgent cases are handled in a timely manner; completes accurate documentation regarding the process
    • Ensures timely and accurate insurance authorization is in place prior to services being provided
    • Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
    • Collaborate with other departments to assist in obtaining pre-authorizations in a cross-functional manner
    • Communicates with patients, clinical partners, financial counselors, and others as necessary to facilitate the authorization process
    • Review the accuracy and completeness of the information requested for prior authorizations and ensure that all supporting documents are present
    • Receive requests for prior-authorizations and ensure that they are properly and closely monitored
    • Process and submit medical records to insurance carriers to expedite prior authorization processes
    • Manage correspondence with insurance companies, internal staff, and specialists as required
    • Look through denials and submit appeals in a bid to get them approved from insurance companies
    • Secure patients’ demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPAA compliance and regulation


    • BA/BS degree required
    • Proficient Microsoft Word, Excel, and other office products required
    • Knowledge of health care and medical terminology required
    • Excellent customer services skills, ability to independently problem-solve, and perform basic mathematical calculation
    • Must have 4+ years experience working in a Healthcare setting

    What we offer:

    • Competitive Salary & Sales Commission
    • Supportive Team
    • Career Growth
    • Commuter Benefits
    • Flexible Work Schedule
    • Paid Vacation, Holidays and Personal Time
    • Medical, Dental and Vision Insurance
    • 401K Retirement Plan
About Company
  • Specialty Infusion is an alternative site of care infusion treatment solution. We offer a low-cost alternative to receiving infusion treatments in a hospital or through a home infusion provider while providing top-quality medical care and amenities to ensure the comfort of our patients.
Recruiter Details
  • HR Specialty Infusion
  • 2127769090