Prior Authorization Coordinator
Join us at IVX Health and help make an impact our patients lives from the start of their patient journey! We are seeking a Prior Authorization Coordinator to support our continued growth! Our HQ is based right outside of Nashville in Brentwood, TN. We are seeking candidates nationwide with the option to work in-office, hybrid, or fully-remote! About Us... IVX Health is a national provider of infusion and injection therapy for those with Rheumatoid Arthritis, Crohn's Disease, Multiple Sclerosis and other complex chronic conditions. IVX offers a different, better approach to caring for our patients and believes it is vital to take the same approach with our employees. We strive to empower our team to succeed while embodying our core values: Be Kind, Do What's Right, Never Settle, Make It Happen, and Enjoy the Ride. About The Role Our Prior Authorization Coordinators form the core of our Revenue Cycle team. Reporting to the Manager of Prior Authorization, the Prior Authorization (PA) Coordinator I works collaboratively and interfaces directly with IVX Health clinical staff, payer representatives, and patients daily to review scheduled services and to ensure complete and accurate information is documented. This role completes necessary clinical review for prior authorizations as required by governmental and commercial payers, satisfying maximum net revenues and minimum avoidable losses for authorizations. The ability to multi-task in multiple business office / practice management systems and offer exceptional customer service is the foundation of this role. Responsibilities Review and process all assigned Prior Authorization orders to completion Obtain clinical information (including but not limited to medical history, diagnosis, and any relevant lab reports) necessary to complete the Prior Authorization Diligently reviews the clinical information for completeness for insurance requirements and follows up with any questions Follow the Prior Authorization Criteria for medications and submits requests Communicate with insurance companies to pre-certify/authorize medications Investigate outstanding medical documentation to ensure a patients account is not suspended Assist with any denied claims to resolve potential mistakes by providing clinical information Assist with medication change process by providing clinical information Clearly support patient experience through patient-centered communications demonstrating excellent customer service skills Assist with payer directed patients from receipt through scheduling while actively communicating with all stakeholders. Perform duties and job functions in accordance with the policies and procedures established for the department Recommend new approaches, policies, and procedures to influence continuous improvements in department's efficiency and services performed Actively participate in problem identification and coordinates resolution between appropriate parties Benefits Comprehensive Medical, Dental, and Vision Insurance plans. Plans include prescription drug coverage as well as telemedicine services Additional options for supplemental health protection plans including Accident, Critical Illness, and Hospital Indemnity, Life and AD&D Insurance Dependent Care Flexible Spending Account Voluntary Short-Term and Long-Term Disability Coverage Fertility Healthcare and Family Building Benefits through Carrot Free counseling services and resources for emotional, physical and financial wellbeing 401(k) Plan with company-match Education assistance (Tuition reimbursement, Certification support) Charitable Giving Match and Volunteer PTO Program Flexible work schedule that promotes a positive work-life balance Employee Referral Bonus Program Apply Job!