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.

• Verify and document insurance eligibility, benefits, and coverage for all office visits and infusion services.
• Obtain insurance authorization and pre-certification for office visits and infusion services.
• Facilitate insurance denial mitigation steps such as peer‑to‑peer reviews and appeals.
• Maintain 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.

• 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 is 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