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Prior Authorization Specialist
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BioHealth Infusion Center
Miami, FL (In Person)
$58,240 Salary, Full-Time
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Job Description
Prior Authorization Specialist -
Position OverviewThe Prior Authorization Specialist plays a critical role in our patient intake process, acting as the primary liaison between patients, referring healthcare providers, and insurance companies. With a commitment to seating and treating every patient within two weeks of referral , this professional is responsible for obtaining and processing all prior authorization requests. The ideal candidate will possess a deep understanding of healthcare insurance processes and biologic infusion therapies to minimize denials and eliminate financial barriers to treatment.
Analyze the root cause of denials, determine what additional information is needed, and resubmit requests. Coordinate peer-to-peer reviews or formal appeals to secure coverage for patients.
Financial Services & Patient Communication Perform accurate insurance verification and coordinate co-pay assistance services so patients can focus on treatment rather than financial burdens . Assist eligible patients in obtaining program funding . Communicate effectively with patients regarding the prior authorization process, potential delays, and financial implications.
Technical Skills Proficiency in medical terminology and coding (CPT and ICD-10) Experience navigating insurance portals and manufacturer co-pay assistance programs. Strong computer skills, including proficiency with electronic health records (EHR) systems.
Professional Attributes Exceptional attention to detail and organizational skills to manage multiple requests and strict deadlines. Strong critical thinking and problem-solving abilities to navigate complex insurance guidelines. Excellent verbal and written communication skills to interact professionally with insurance representatives, clinical staff, and our patients.
BioHealth Infusion Center Company:
BioHealth Infusion CenterPosition Type:
Full-Time Location:
Onsite | 8684Sunset Drive, South Miami, FL Compensation:
Competitive Pay +Benefits About BioHealth Infusion Center:
With over 25 years of healthcare experience, BioHealth Infusion Center is South Florida's premier destination for cutting-edge, evidence-based infusion therapy . We are dedicated to delivering exceptional patient care in a comfortable, state-of-the-art facility. Our comprehensive approach empowers patients to manage complex diseases through innovative biologic and non-biologic infusions . At BioHealth, we treat every patient like family, ensuring a stress-free experience from the initial intake process through the entirety of their therapy . We are seeking a detail-oriented and proactive Prior Authorization Specialist to join our dedicated clinical and administrative team. In this role, you will ensure our patients receive seamless access to life-enhancing therapies by securing necessary insurance approvals quickly and efficiently.Position OverviewThe Prior Authorization Specialist plays a critical role in our patient intake process, acting as the primary liaison between patients, referring healthcare providers, and insurance companies. With a commitment to seating and treating every patient within two weeks of referral , this professional is responsible for obtaining and processing all prior authorization requests. The ideal candidate will possess a deep understanding of healthcare insurance processes and biologic infusion therapies to minimize denials and eliminate financial barriers to treatment.
Key Responsibilities:
Review patient accounts and initiate pre-authorizations for biologic and non-biologic infusion therapies. Collect demographic, insurance, and clinical information to ensure all reimbursement requirements are met prior to treatment. Work quickly to obtain insurance approvals, striving for success upon first-time submission to meet our two-week treatment goal . Clinical Collaboration & DocumentationWork closely with referring physicians and our internal clinical staff (including our Medical Directors and APRNs) to gather necessary clinical documentation . Enter and record authorization documentation accurately within the patient's electronic medical records. Ensure strict compliance with specific insurance carrier requirements for specialized infusion medications. Denial Management and AppealsInvestigate insurance denials promptly to prevent delays in patient care.Analyze the root cause of denials, determine what additional information is needed, and resubmit requests. Coordinate peer-to-peer reviews or formal appeals to secure coverage for patients.
Financial Services & Patient Communication Perform accurate insurance verification and coordinate co-pay assistance services so patients can focus on treatment rather than financial burdens . Assist eligible patients in obtaining program funding . Communicate effectively with patients regarding the prior authorization process, potential delays, and financial implications.
QualificationsExperience and Education:
High School diploma or equivalent required; Associate's or Bachelor's degree in Healthcare Administration or a related field preferred. Minimum of 2-3 years of experience in medical billing, revenue cycle management, or processing prior authorizations. Specific experience with prior authorizations for infusion therapies or biologic medications is highly preferred.Technical Skills Proficiency in medical terminology and coding (CPT and ICD-10) Experience navigating insurance portals and manufacturer co-pay assistance programs. Strong computer skills, including proficiency with electronic health records (EHR) systems.
Professional Attributes Exceptional attention to detail and organizational skills to manage multiple requests and strict deadlines. Strong critical thinking and problem-solving abilities to navigate complex insurance guidelines. Excellent verbal and written communication skills to interact professionally with insurance representatives, clinical staff, and our patients.