Prior Authorization Specialist

Infusion For Health is dedicated to serving patients with autoimmune disorders and complex chronic conditions through exceptional infusion therapy. Our mission is to provide a patient-focused environment that emphasizes professional care, compassion, and collaboration to ensure optimal treatment outcomes.

The Prior Authorization Representative plays a critical role in securing timely insurance approvals for specialty and infusion medications. This position ensures that all required documentation is obtained and submitted to payers to facilitate patient access to therapy. The ideal candidate will have experience working in a specialty or infusion pharmacy and a strong understanding of insurance verification and the prior authorization process for high-cost medications.

Key Responsibilities:

• Review new infusion referrals and coordinate benefits investigation for commercial and government payers.
• Obtain and submit all necessary clinical documentation and forms to insurance companies for prior authorization requests.
• Proactively follow up with payers, providers, and internal teams to resolve any delays in the authorization process.
• Communicate approval or denial outcomes to patients, prescribers, and pharmacy staff.
• Collaborate with clinical and billing teams to escalate issues related to denied or delayed authorizations.
• Document all communication and authorization statuses in pharmacy software or CRM systems.
• Maintain working knowledge of payer-specific policies for infusion therapies, including Medicare, Medicaid, and commercial plans.
• Monitor and track prior authorization expirations and initiate reauthorization processes as needed.
• Provide exceptional customer service while managing high call and task volumes.
• Stay up-to-date on regulatory and payer changes impacting the prior authorization process.

QUALIFICATIONS

• At least 2 years of experience in infusion or pharmacy prior authorization is required.
• At least 2 years of experience applying knowledge of Medicare, Medicaid, and Managed Care reimbursement guidelines.
• Ability to effectively handle multiple priorities within a changing environment, emphasizing paperless workflow.
• Experience in diagnosing, isolating, and resolving complex issues and recommending and implementing strategies to resolve problems.
• Organizational skills are sufficient to maintain consistently accurate records.
• Intermediate level skills in Microsoft Excel & Word. 
• Computer skills that include proficiency with spreadsheets and use of the internet, as well as word processing, and efficient use of the internet and e-mail. 
• Certification as a Pharmacy Technician (preferred) and/or hold an active Pharmacy Technician license. 
• Current knowledge of all applicable state and federal pharmacy laws, rules, and regulations