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Job Description
Prior Authorization Specialist Empowered Arthritis and Rheumatology Center PLLC Cary, NC Job Details Full-time 6 hours ago Benefits Health insurance Dental insurance Paid time off Vision insurance Professional development assistance Qualifications Appeals Teamwork Microsoft Excel Medical documentation Microsoft Outlook Overseeing health insurance pre-certification Care documentation Patient service High school diploma or GED Medical billing discrepancy resolution Case appeal in utilization management Electronic health record (EHR) management for billing and coding Attention to detail Care coordination Insurance claims appeal handling Medical billing insurance follow-up Full Job Description Prior Authorization Specialist Specialty Medications / Biologics•
On-site, full-time Position Summary We are a Rheumatology practice with an on-site infusion suite, and we are looking for a Prior Authorization Specialist to keep our patients moving smoothly from prescription to treatment. In this role, you will own the prior authorization, benefit verification, and patient financial-assistance process for specialty and biologic medications, serving as the link between patients, providers, payers, specialty pharmacies, and drug manufacturers. This is a great fit if you have prior authorization, benefit verification, or specialty pharmacy experience and want to grow into the specialty-drug and infusion space. You do not need a rheumatology background to apply. If you are strong on the prior authorization fundamentals, we will train you on our specialty workflows, payer rules, and the medications we use. Key Responsibilities Authorization & Access Management Prepare and submit prior authorizations for specialty and biologic medications through payer portals and electronic prior authorization (ePA) platforms such as CoverMyMeds, SamaCare, or SureScripts. Track approvals, work denials and appeals, and submit renewals before they expire. Partner with providers to gather the clinical documentation each authorization needs (labs, step-therapy history, diagnosis codes). Financial Coordination & Patient Support Run benefit investigations to determine coverage under the medical vs. pharmacy benefit. Enroll eligible patients in manufacturer copay assistance, bridge, and free-drug programs to reduce out-of-pocket cost. Walk patients through their benefits, enrollment requirements, and the timeline to get their medication. Billing, Coding & Revenue Cycle Support Verify coverage and reimbursement parameters for buy-and-bill and specialty pharmacy fulfillment models. Support billing staff with accurate CPT, ICD-10, and HCPCS coding for biologic administration and infusion services. Review claim submissions through a clearinghouse tool, identify rejections and denials, and initiate resolution or rebill. Track payer responses and reimbursement timelines so claims process accurately and on time. Patient Education & Clinical Workflow Educate patients on their biologic therapy•how it is administered (infusion or injection), the treatment schedule. Coordinate with the infusion suite on scheduling, inventory availability, and authorization clearance. Document all communications and actions in the EMR to keep records accurate and current. Communication & Practice Coordination Serve as the primary point of contact for patients, providers, insurers, and specialty pharmacies on biologic-therapy questions. Act as the liaison between the clinical team, infusion suite, billing department, and pharmaceutical representatives for a coordinated patient experience. Required Qualifications We are looking for the prior authorization fundamentals below. If you have these, we will train you on the rheumatology and infusion specific parts of the role. High school diploma or equivalent. 1-2+ years of experience in prior authorization, benefit verification, specialty pharmacy, or a medical-office revenue cycle role. Hands-on experience with at least one electronic prior authorization platform or payer portal•for example CoverMyMeds, SamaCare, SureScripts, or a payer-specific portal. Familiarity with insurance verification and working denials and appeals. Comfortable documenting in an EMR (e.g., eClinicalWorks, Epic, Athenahealth, or NextGen). Proficient with Microsoft Office (Word, Excel, Outlook). Detail-oriented, organized, and dependable on follow-through, with strong written and verbal communication skills. A compassionate, patient-focused approach to care coordination. Preferred Qualifications Any of these are a plus: Prior experience as a Biologic Coordinator, Patient Access Specialist, Reimbursement Specialist, or in a manufacturer patient-support / hub role. Rheumatology, dermatology, gastroenterology, or similar specialty experience. Direct experience with specialty biologics such as Humira, Enbrel, Remicade, Actemra, Cimzia, or Stelara. Working knowledge of CPT, ICD-10, and HCPCS (J-code) coding for specialty drugs and infusion services. Experience with buy-and-bill reimbursement and infusion suite operations. Experience with a clearinghouse tool such as TriZetto for tracking and resolving claim denials. Licensure or certification such as LPN, CMA, RMA, or CPhT. Why Join Us Specialized, in-demand skills: you will deepen your expertise in specialty drugs, infusion, and buy-and-bill reimbursement gaining a strong growth path in healthcare revenue cycle and patient access. Predictable weekday schedule with no nights or weekends. A collaborative team that supports patients through some of the most meaningful moments in their treatment.
Benefits:
Dental insurance Health insurance Paid time off Professional development assistance Vision insurance
