Authorization Specialist (Medical Insurance)

Location: Remote within the United States

Company

hirify.global supports community oncologists through a patient-centric, physician-driven, and technology-powered healthcare model.

What you will do

• Obtain pre-authorizations for physician-ordered diagnostic testing and procedures.
• Verify insurance benefits and communicate reimbursement or pre-certification requirements to physicians and clinical staff.
• Document authorization approvals and denials in the electronic medical record.
• Coordinate with front office staff, imaging centers, hospitals, insurance coordinators, and clinical trial teams to resolve coverage issues.
• Complete retro-authorization requests and medically necessary appeals from the denial worklist.
• Review payer medical-necessity, frequency, and prior-testing requirements while supporting process projects and staff training.

Requirements

• High school diploma or equivalent.
• At least 1 year of prior authorization experience.
• Medical insurance experience is required.
• Working knowledge of hospice and other payer requirements, clinic procedures, medical practice, and medical terminology.
• Proficiency with Microsoft Word, Excel, Outlook, databases, patient scheduling systems, and medical information systems.
• Strong communication, customer service, organization, problem-solving, multitasking, and attention-to-detail skills.

Culture & Benefits

• Values-driven culture with startup enthusiasm and support from leaders in oncology, urology, technology, and finance.
• Opportunity to improve processes supporting independent physicians and their patients.
• Full-time remote work arrangement within the United States.