Medical Authorizations Specialist (Infusion Centers) - Pembroke Pines FL Coastal Medical Group Pembroke Pines, FL Job Details Full-time From $22 an hour 3 hours ago Benefits Health insurance Dental insurance 401(k) Paid time off Vision insurance Qualifications Overseeing health insurance pre-certification Medical insurance coverage verification Full Job Description

PRIOR AUTHORIZATION SPECIALIST

- Infusion Centers Pembroke Pines, FL Coastal Medical Group is seeking an experienced Prior Authorization Specialist to join our growing team. Under the direction of our Associate Medical Director, you will be responsible for securing insurance authorizations for infusions of biologics and other specialty medications for our infusion centers, Coastal Infusion. You will work closely with patients, our healthcare providers and staff, insurance companies, and our pharmacy team to ensure timely approval of treatment plans and medication access. The ideal candidate will have strong communication skills, a deep understanding of insurance processes, and a passion for helping patients access critical therapies. In addition, preference will be given to candidates who have experience securing authorizations for rheumatology gastroenterology neurology medical infusion (including oncology) or specialty pharmacy. This is a full-time position, Monday through Friday. --- KEY

RESPONSIBILITIES

Insurance Verification & Authorization:

Submit Prior-Auth Requests:

Prepare and submit prior authorization requests through payer portals, electronic prior authorization platforms, fax, and phone to all major payers (insurance companies) in south Florida, ensuring that required documentation, including letters of medical necessity and clinical information, is accurately submitted.

Collect Documentation :

Download most required information from the electronic medical record (EMR) systems belonging to Coastal Medical Group companies, including eClinical Works and eMedical. When necessasry work with in-house medical providers to gather additional required documentation.

Monitor and Follow-Up:

Monitor authorization status and follow up with insurance companies to ensure timely processing.

Appeal Denials:

Identify authorization denials and coordinate appeals, reconsiderations, and peer-to-peer review requests when appropriate.

Maintain EMR Data:

Maintain detailed records of authorization activity within our infusion center EMR, WeInfuse.

Patient & Provider Liaison:

Serve as the main

Point of Contact:

Interact with patients and providers regarding insurance authorizations and coverage questions.

Educate Patients:

Explain insurance processes, including prior authorization requirements, medication coverage, and financial assistance programs to patients.

Compliance and Quality:

Ensure HIPAA Compliance Ensure Accuracy and completeness of documentation.

Stay Current:

Ensure understanding of payer policies, formularies, and authorization requirements. --- MINIMUM

REQUIREMENTS

We regret that we cannot consider applications that do not show evidence of all three of these requirements :

Education:

Candidates must have completed at least a two-year college degree in healthcare or a related field. Two years' additional work experience may be substituted.

Experience:

Minimum of 2 years of experience in insurance authorizations at a specialty pharmacy or a medical specialist's office (for example rheumatology, gastroenterology, neurology).

Skills & Knowledge:

A comprehensive understanding of insurance verification of specialty medications such as those for IV infusion or chemotherapy. Preference will be given to candidates with the following additional qualifications :

Rheumatology or Related Experience:

Experience with rheumatology, gastroenterology, neurology, medical infusion (including oncology) or specialty pharmacy prior authorizations is strongly preferred

Bilingual:

This means that you can communicate fluently and with confidence in both English and Spanish. ---

WHAT YOU GET Compensation:

Starting at $22.00/hour, with higher compensation available based on experience and qualifications.

Benefits:

Medical, dental, vision Generous paid time off 401(k) plan

Standard Hours:

Work regular business hours, Monday-Thursday, and until early afternoon on Fridays.

Exceptional Team:

The Coastal Medical team has been recognized as among the best in the business; you'll work with highly-motivated and compassionate team members with a passion for patient care. --- ABOUT US Coastal Medical Group is a fast-growing medical provider, including South Florida Rheumatology (south Florida's first rheumatology office), the Rheumatology Center Inc, Coastal Infusion, and Water Lilly Pharmacy, and a non-profit community health center in south Florida. We are expanding and interested in continuing to find driven team members to contribute to our mission of delivering exceptional patient care. Coastal Medical Group is committed to providing an environment of mutual respect. We offer employment without regard to race, color, religion, sex, pregnancy, national origin, age, disability, marital status, sexual orientation, gender identity, gender expression, military and veteran status, and any other characteristic protected by law. We believe that diversity is critical to our success as a company. We are an inclusive workplace where employees excel based on personal merit, qualifications, experience, ability, and job performance. Minority candidates are encouraged to apply. .

JOB SEEKERS ONLY COASTAL MEDICAL GROUP HAS A STRICT POLICY PROHIBITING THE PAYMENT OF FEES TO HEADHUNTERS OR EMPLOYMENT AGENCIES. ANY REFERRALS SUBMITTED WILL BE CONSIDERED FREE REFERRALS. NO FEES WILL BE PAID.

Job Type:

Full-time Pay:

From $22.00 per hour Application Question(s): We know it's on your resume, but if you don't mind, please summarize the number of years' experience you have in a prior authorization role? Is this at a specialist office (rheum, gastro, neuro, pharmacy) or somewhere else?

Work Location:

In person