Prior Authorization Coordinator I

Description

Join Our Team as a Prior Authorization Coordinator I at IVX Health!

Are you experienced in navigating the complexities of prior authorizations for biologics or oncology therapies? IVX Health is looking for a driven and detail-oriented Prior Authorization Coordinator to support our rapidly growing team. In this role, you’ll have the opportunity to make a meaningful impact by facilitating the approval process for life-changing specialty treatments. 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! With hybrid or fully remote options, you can thrive in a flexible work environment while contributing to patient-centered care.

About the Role
As a Prior Authorization Coordinator I, you'll play a vital role in ensuring the timely and accurate processing of prior authorization (PA) requests for biologics, oncology treatments, and other specialty therapies. Working closely with clinical staff, insurance companies, and patients, you’ll help streamline access to critical medical services. Your experience with biologics and oncology prior authorizations will be essential to ensuring that patients receive their treatments without delay.

What You'll Do

• Review and Process Prior Authorizations: Accurately review PA requests, gather clinical information, and ensure completion per payer guidelines.
• Clinical Documentation: Collect necessary medical records, lab reports, and diagnostic information to support PA submissions.
• Submission & Follow-up: Submit PA requests to insurance companies and communicate effectively with payer representatives to ensure approval.
• Resolve Issues: Address denied claims by providing additional clinical information or documentation, and work with clinical staff to resolve outstanding issues.
• Patient Communication: Keep patients and other stakeholders informed about the status of their authorizations.
• Compliance: Stay up to date with payer policies and ensure compliance with healthcare regulations, particularly for biologics and oncology therapies.

What You Bring

• Proven experience in processing prior authorizations for biologics or oncology therapies.
• Ability to navigate complex insurance guidelines for both governmental and commercial payers.
• Strong analytical skills to review clinical information accurately.
• Excellent communication skills, both written and verbal, to interact with clinical teams, insurance companies, and patients.
• The ability to thrive in a fast-paced, patient-centered environment.

Why IVX Health?
IVX Health is a leading provider of infusion and injection therapy for patients with chronic conditions. We are committed to creating a supportive, patient-first work environment that empowers our employees to succeed. At IVX Health, you’ll have the chance to grow your career while making a difference in the lives of patients every day.

Work Environment:
This position offers flexibility with hybrid or fully remote work options, allowing you to maintain work-life balance while contributing to a team that values excellence and patient care.

What’s In It for You?
This role is ideal for someone who thrives on challenges, values autonomy, and is excited by the opportunity for professional growth. With regular exposure to our executive leadership team and the heads of business units, you’ll have the chance to make a significant impact while furthering your career in a collaborative, innovative environment.

Benefits

• Comprehensive Healthcare: Medical, dental, and vision plans with prescription drug coverage and telemedicine services.
• Flexible Savings: Health Savings Account (HSA) and Health Reimbursement Arrangement (HRA) options.
• Supplemental Coverage: Additional plans for Accident, Critical Illness, and Hospital Indemnity.
• Dependent Care FSA: Pre-tax dollars for eligible dependent care expenses.
• Disability Coverage: Voluntary short-term and long-term disability options.
• Fertility and Family Support: Resources for fertility healthcare and family building.
• Life and AD&D Insurance: Coverage for you and your loved ones.
• Counseling Services: Free counseling for emotional, physical, and financial wellbeing.
• Education Assistance: Tuition reimbursement and certification support.
• CEU Library: Access to Continuing Education Units for career advancement.
• Charitable Giving and Volunteer Program: Matched charitable contributions and volunteer PTO.
• Employee Referral Bonus: Earn bonuses for referring talented individuals.
• 401(k) Plan: Save for retirement with company matching.

Qualifications

ESSENTIAL SKILLS AND COMPETENCIES

• Proficiency in managing prior authorizations for biologics and oncology therapies, including navigating complex payer guidelines and high-cost medication approvals.
• Proficient in understanding and navigating the complexities of Prior Authorization (PA) processes for both governmental and commercial payers.
• Demonstrates strong analytical thinking to review and interpret clinical information accurately for PA submissions. 
• Exceptional verbal and written communication skills to interact professionally with IVX Health clinical teams, insurance companies, and patients.
• Ability to thrive in a fast-paced environment, managing multiple PA requests simultaneously while maintaining attention to detail and meeting deadlines.
• Knowledgeable about current healthcare regulations, particularly HIPAA guidelines, ensuring confidentiality and integrity in handling patient information during PA activities.
• Competent in using various office software applications such as Microsoft Office Suite (Word, Excel, Outlook), electronic health record (EHR) systems, and practice management software.

REQUIRED EDUCATION AND EXPERIENCE

• High School Diploma or GED required.
• Minimum three (3) years of experience working in hospital or clinical service access, physician office scheduling, or similar role.
• 2 Year / Associate's degree in Medical Office Management, Medical Insurance, or Medical Coding strongly preferred.
• Certified Medical Assistant is a plus!
• Experience with prior authorizations for biologics, oncology, or specialty therapies preferred.

WAGE RANGE
Pay is based on a number of factors including market location, job-related knowledge, skills, and experience and is benchmarked against similar organizations to our size and industry. For our Prior Authorization Coordinator role, we generally pay new hires between 20.00 and 24.00 per hour. It is not typical for an individual to be hired at or near the top of the range for roles and compensation decisions are dependent on the facts and circumstances of each situation. In addition to cash pay, full-time regular positions are eligible for 401(k), health benefits, and other company benefits; some of these benefits may also be available for part-time positions.

EEO STATEMENT
IVX Health is proud to be an Equal Opportunity Employer. We value diversity and are committed to creating an inclusive environment for all employees. IVX Health wants to have the best available people in every job, and we make employment decisions on the basis of business needs, job requirements, individual qualifications, and merit. Equal employment opportunities are provided to all employees and applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, pregnancy, national origin, military and veteran status, age, physical or mental disability, genetic characteristic, reproductive health decisions, family or parental status, or any other legally protected category in accordance with applicable federal, state, or local laws. IVX Health prohibits discrimination, harassment, or retaliation of any kind based on any of these characteristics. Equal employment opportunity will be extended to all persons in all aspects of the employer-employee relationship and all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation benefits, and separation of employment.