Benefits and Authorizations Specialist, Lead

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Nira Medical Group

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

Healthcare Insurance

Nira Medical Group is a national practice platform focused on transforming neurological care by making life-changing treatment more accessible to patients. The organization empowers neurologists by providing a comprehensive range of services, allowing them to deliver world-class care. By uniting top physicians and employing a physician-led model, Nira Medical enhances healthcare outcomes through expanded access and the integration of advanced neurological practices and services under one roof. The group aims to ease administrative burdens on healthcare professionals and deliver comprehensive patient care, including ancillary services such as infusion, clinical research, and imaging.

📋 Description

• Verify and document insurance eligibility, benefits, and coverage for all office visits and infusion services. • Obtains insurance authorization and pre-certification for office visits and infusion services. • Facilitate insurance denial mitigation steps such as peer-to-peer reviews and appeals. • Maintains a good working knowledge of infusion drug authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization. • Calculate and communicate patient financial responsibility. • Provide financial assistance support to patients including identifying patient assistance programs and manufacturer copay assistance enrollment.

🎯 Requirements

• High school diploma or equivalent • 2-3 years of experience in medical insurance verification and prior authorizations. Experience in infusion services is preferred. • Knowledge of insurance terminology, plan types, structures, and approval types • Previous experience with J-codes, CPT and ICD-10 coding • Previous Athena use a plus, but not a requirement • Knowledge of medical terminology and clinical documentation review • Strong organizational skills • Detail-oriented • Ability to multi-task and work well in a fast-paced setting • Critical thinking skills and decisive judgment

🏖️ Benefits

• Verify and document insurance eligibility, benefits, and coverage for all office visits and infusion services. • Obtains insurance authorization and pre-certification for office visits and infusion services. • Facilitate insurance denial mitigation steps such as peer-to-peer reviews and appeals. • Maintains a good working knowledge of infusion drug authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization. • Calculate and communicate patient financial responsibility. • Provide financial assistance support to patients including identifying patient assistance programs and manufacturer copay assistance enrollment.