What are the responsibilities and job description for the PRIOR AUTHORIZATION SPECIALIST position at Healix, LLC?
Healix Infusion Therapy is seeking a full-time, remote Prior Authorization Specialist to join our Corporate Clinical Review Team.
As a Prior Authorization Specialist with Healix, you will have the opportunity to work as a key member of the Clinical Review Team to review referrals for payor criteria to facilitate prior authorization and approvals for the Business Office. This is an excellent opportunity for clinicians who want a more clinical role in the outpatient setting.
Duties & Responsibilities
Healix is the nation’s leader in providing physician office-based infusion services. Focused on patient and physician peace of mind for 30 years, we offer unparalleled capabilities for optimal patient care, comfort, compliance, clinical outcomes, and research in an outpatient setting.
At Healix, we manage Office Infusion Centers on behalf of physicians, hospitals, and medical institutions, encouraging in-office treatment for optimal patient care. Our company is headquartered in Sugar Land, Texas, a suburb of Houston, where we have helped establish and manage hundreds of infusion centers nationwide. We use our clinical and business expertise to provide integrated solutions for all aspects of the infusion program, including research, all while delivering peace of mind to our clients and their patients.
Studies show that the physician office infusion center setting provides significant site of care benefits for patients, communities, payors, and pharma, including superior clinical outcomes and lower cost of care. Overall patient satisfaction at Healix-managed infusion centers soars, with 98% of patients rating their care as excellent. Our physician clients rely on Healix to handle their infusion center operations and research endeavors. As Healix continues to grow and expand in clinical research, we are dedicated to maintaining focus on patient and physician peace of mind.
Education And/or Experience
As a Prior Authorization Specialist with Healix, you will have the opportunity to work as a key member of the Clinical Review Team to review referrals for payor criteria to facilitate prior authorization and approvals for the Business Office. This is an excellent opportunity for clinicians who want a more clinical role in the outpatient setting.
Duties & Responsibilities
- Reviews referral medical record documentation and evaluates medical criteria in accordance with payor policies to facilitate prior authorizations and approvals for select assigned therapies.
- Maintains complete, timely and accurate documentation of reviews.
- Transfers all clinical questions, escalations and judgment calls to the pharmacist team.
- Communicates consistently and frequently to sites and staff regarding patient referral status, documentation needed and/or order clarifications.
- Manages the daily queue for clinical reviews and ensures all tasks are completed each day.
- Be current and proficient in understanding prior authorization requirements for selected therapies, including but not limited to rheumatology, neurology, and gastroenterology.
- Assists with generating site-specific template orders.
- Responsible for assessing and reporting department key performance metrics.
- Other tasks assigned in support of the pharmacist team and company.
Healix is the nation’s leader in providing physician office-based infusion services. Focused on patient and physician peace of mind for 30 years, we offer unparalleled capabilities for optimal patient care, comfort, compliance, clinical outcomes, and research in an outpatient setting.
At Healix, we manage Office Infusion Centers on behalf of physicians, hospitals, and medical institutions, encouraging in-office treatment for optimal patient care. Our company is headquartered in Sugar Land, Texas, a suburb of Houston, where we have helped establish and manage hundreds of infusion centers nationwide. We use our clinical and business expertise to provide integrated solutions for all aspects of the infusion program, including research, all while delivering peace of mind to our clients and their patients.
Studies show that the physician office infusion center setting provides significant site of care benefits for patients, communities, payors, and pharma, including superior clinical outcomes and lower cost of care. Overall patient satisfaction at Healix-managed infusion centers soars, with 98% of patients rating their care as excellent. Our physician clients rely on Healix to handle their infusion center operations and research endeavors. As Healix continues to grow and expand in clinical research, we are dedicated to maintaining focus on patient and physician peace of mind.
Education And/or Experience
- Current certification as a pharmacy technician (CPhT) or MA is required
- Bachelor's degree is preferred
- 2-3 years of prior authorization experience
- Computer proficient in electronic medical record systems and Microsoft Office Suite: Outlook, Excel and Word required; PowerPoint preferable
- Knowledgeable in medical terminology, generic and trade pharmaceutical names, and pharmaceutical calculations to ensure accurate claims processing
- Must possess strong analytical and communication skills, including written, verbal, grammar, and listening skills
- Self-motivated and able to multitask effectively
- Excellent teamwork skills required
