Specialty – Authorization & Verification Specialist Position Available In Knox, Tennessee

Specialty – Authorization & Verification Specialist ContinuumRx Knoxville, TN Company Overview ContinuumRx has been a trusted partner in healthcare for over fifteen years, specializing in improving post-acute care coordination and management. Our commitment to enhancing patient experiences and supporting healthcare providers is reflected in our accreditation through the Accreditation Commission for Health Care (ACHC). We deliver high-quality infusion therapies and services to patients, ensuring they receive the best possible care throughout their healthcare journey. Summary We are seeking an Authorization Specialist to join our team at ContinuumRx. In this role, you will be pivotal in managing insurance authorizations and ensuring that patients receive timely access to necessary therapies. Your expertise will contribute significantly to our mission of improving patient outcomes and supporting healthcare providers. Responsibilities The primary role of the Authorization Specialist is to review, process, and follow to completion the requirement of obtaining prior authorization for services. This excludes PBM authorizations. Coordinates with the Intake Specialists and the Clinical Review Team to identify and process requests for services requiring Prior Authorization and/or Pre-Determination for services rendered. Assists the Clinical Review Team as necessary to obtain authorizations for specialty and complicated therapies. Reviews each request for Prior Authorization and insures that the proper supporting documentation and forms/documents are completed. Processes Prior Authorizations via Fax, computer or phone call as required by the specific payers. Maintains an organized process for documenting and tracking all requested prior authorizations. Maintains an organized process for timely follow-up and troubleshooting of all pending Prior Authorizations. Documents in the patient record all prior authorizations, expiration dates and other information as required. Communicates with the Clinical Review Team and Admission Specialists any prior authorization denials and insures prompt follow-up. Maintains a process to review newly accepted patients for a “second check” to prevent missing prior authorization requests. Serves as a backup for the Intake Assistant in monitoring incoming fax queue and assigning to appropriate personnel. Serves as backup for Intake Assistant in management of incoming calls through the company switchboard; covers the switchboard during the Intake Assistant’s breaks as necessary and on his/her days out of the office. Effectively identify and communicate to supervisor when assistance is needed (including, but not limited to system function, training, etc.) Observes legal and ethical guidelines for safeguarding patient and company confidentiality (HIPAA) Understands and provides exceptional customer service to clients, patients, and payers. Exhibits a positive, courteous, respectful and helpful attitude to clients, co-workers, and management team. Promotes company culture by adhering to all policies and procedures Adapts to and demonstrates the ability to deal with frequent changes in the work environment. Other tasks/duties as assigned. Complete understanding of confidentiality with respect to Company proprietary information as well as information concerning patient/client care; complying with all federal and state laws as apply to confidentiality of protected health information (PHI) and electronic protected health information (EPHI); and following HIPAA guidelines regarding readily identifiable protected health information. Requirements Proven experience in insurance verification and authorization processes. Minimum of High School Diploma or GED. Knowledge of medical terminology preferred, but not required. Strong knowledge of medical coding (ICD-9, ICD-10) and medical terminology. Familiarity with managed care systems is preferred. Excellent communication skills for effective interaction with patients and healthcare providers. Detail-oriented with strong organizational skills to manage multiple requests efficiently. Understanding of HIPAA regulations to ensure patient confidentiality. If you are passionate about improving patient care through effective authorization processes, we invite you to apply today and become a part of our dedicated team at ContinuumRx!

Job Type:

Full-time Benefits:

401(k) 401(k) matching Dental insurance Health insurance Life insurance Paid time off Vision insurance

Work Location:

Remote