Benefits and Authorizations Specialist Lead

Job Summary : The Benefits Specialist Lead is responsible for verifying patient insurance coverage, submitting pre-authorizations, and financial assistance support to ensure patients receive coverage for medical and infusion services provided.

Key Responsibilities :

Verify and document insurance eligibility, benefits, and coverage for all office visits and infusion services.

Obtains insurance authorization and pre-certification for office visits and infusion services.

Facilitate insurance denial mitigation steps such as peer-to-peer reviews and appeals.

Maintains a good working knowledge of infusion drug authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization.

Calculate and communicate patient financial responsibility.

Provide financial assistance support to patients including identifying patient assistance programs and manufacturer copay assistance enrollment.

Qualifications :

High school diploma or equivalent

2-3 years of experience in medical insurance verification and prior authorizations. Experience in infusion services is preferred.

· Knowledge of insurance terminology, plan types, structures, and approval types

· Previous experience with J-codes, CPT and ICD-10 coding

Previous Athena use a plus, but not a requirement

· Knowledge of medical terminology and clinical documentation review

Strong organizational skills

Detail-oriented

Ability to multi-task and work well in a fast-paced setting

Critical thinking skills and decisive judgment