[Hiring] Prior Authorizations Specialist @Pure Infusion Suites

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Prior Authorization Specialist is a vital team member responsible for efficiently managing the prior authorization process to ensure seamless patient care and timely treatment. This position requires a solid understanding of medical benefits, step therapy, and authorization policies, along with exceptional organizational, communication, and problem-solving skills. • Manage a caseload of at least 30 active authorizations • Navigate systems such as Salesforce, WeInfuse, and AMD to track and update case progress • Process prior authorizations accurately and efficiently • Manage appeals and denials, escalating cases when necessary • Analyze insurance policies for each case and communicate with internal teams or providers • Verify insurance benefits and determine in-network (INN) or out-of-network (OON) status • Evaluate medical and pharmacy benefits to determine patient eligibility for treatment • Maintain clear, professional communication with providers, patients, internal teams, and stakeholders • Document all case-related conversations and updates within Salesforce • Prioritize personal tasks and authorizations to ensure timely completion • Collaborate with internal team members to gather or clarify case information • Investigate and resolve complex cases using strong critical thinking and problem-solving skills • Organize and manage authorization workload efficiently to meet performance goals • Follow and produce by Intake standards for accuracy and completion standards Qualifications • Minimum 2-3 years of experience as a Medical Assistant (MA), with direct prior authorization and biologic therapy experience • Proven ability to interpret clinical documentation and understand commercial and Medicare Advantage policies • Strong experience working with systems like Salesforce, WeInfuse, and AMD • Background in a specialty field such as Rheumatology, Gastroenterology, Dermatology, Neurology, or Immunology preferred • Excellent communication and customer service skills with both clinical teams and patients • Highly organized and capable of managing multiple priorities in a fast-paced environment • Strong documentation habits and time management skills Requirements • High School diploma or equivalent required • Certification or formal training as a Medical Assistant required • Biologic Authorization experience required • Must meet U.S. employment eligibility requirements • Proficiency with EMRs, CRMs (Salesforce), and prior authorization systems • Works comfortably in software like a PMS or EMR to track information, schedule and make notes • Ability to meet U.S. employment and eligibility requirements