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