We are looking for an experienced Medical Insurance Authorization Specialist to join our team in Denver, Colorado. This fully onsite role requires a background in pharmacy and a strong understanding of insurance authorization processes. The selected candidate will play a critical part in ensuring appropriate insurance approvals for growth hormone therapies and other medical needs, contributing to an enhanced patient experience.
Key Responsibilities
Insurance Authorizations: Process statements of medical necessity and secure prior authorizations for growth hormone therapies by contacting insurance providers directly.
Approval Management: Manage approvals, denials, and appeals for submitted authorizations, including resolving issues as they arise.
Administrative Tasks: Handle online submissions, manage significant amounts of paperwork, and ensure records are accurately maintained.
Patient and Family Communication: Regularly update families on the status of authorizations, including delivering both positive and challenging news with sensitivity and professionalism.
Team Collaboration: Act as a backup for the team, stepping in to assist when needed and ensuring a seamless workflow.
Correspondence: Handle approximately 20-30 calls per day and maintain email correspondence with insurance providers, families, and medical teams.
Problem-Solving: Help navigate complex authorization processes and ensure that families and medical staff are guided and supported.
Qualifications
Experience:
At least 2 years of experience in a pharmacy setting (retail, hospital, or specialty pharmacy preferred).
Previous experience handling insurance authorizations is required.
Skills:
Strong organizational and multitasking skills to manage high volumes of paperwork, online submissions, and phone/email communication.
Excellent verbal and written communication skills to handle sensitive conversations with families and third parties effectively.
Problem-solving skills to navigate denials, appeals, and other challenges.
Technical Proficiency: Familiarity with medical billing software, insurance portals, and Microsoft Office Suite. Epic or similar EMR experience is a plus.
Education: High school diploma or GED required; healthcare-specific certifications or training a plus.