Benefits and Authorizations Specialist Lead

Nira Medical
United States
Workplace: RemoteFull timeFunction: Administration & Executive AssistanceEducation: high_schoolSkills: ["Organization","Detail-oriented","Multitasking","Critical thinking","Communication"]

Lead the Benefits and Authorizations team to verify patient insurance eligibility, obtain pre-authorizations, and coordinate financial assistance to ensure coverage for infusion and medical services. You will work cross-functionally with payer providers, clinical staff, and patients to mitigate denials and communicate financial responsibilities. This role drives authorization accuracy, payer compliance, and access to infusion therapies across the patient journey.

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FursaFursa
Nira Medical
Nira Medical
1 year ago

Benefits and Authorizations Specialist Lead

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Source: Company careers pageValidated by: Fursa AI
Last checked: 22 hours agoStatus: Live

Job Summary

Lead the Benefits and Authorizations team to verify patient insurance eligibility, obtain pre-authorizations, and coordinate financial assistance to ensure coverage for infusion and medical services. You will work cross-functionally with payer providers, clinical staff, and patients to mitigate denials and communicate financial responsibilities. This role drives authorization accuracy, payer compliance, and access to infusion therapies across the patient journey.
Location: United States
Workplace: Remote
Employment Type: Full time
Job Function: Administration & Executive Assistance
Seniority: Sr. Manager level

Key Responsibilities

  • •Verify and document insurance eligibility, benefits, and coverage for all office visits and infusion services.
  • •Obtain insurance authorization and pre-certification for office visits and infusion services.
  • •Facilitate insurance denial mitigation steps such as peer-to-peer reviews and appeals.
  • •Maintain knowledge of infusion drug authorization requirements for payers and regulatory guidelines.
  • •Calculate and communicate patient financial responsibility.

Key Requirements

  • •High school diploma or equivalent.
  • •2-3 years of experience in medical insurance verification and prior authorizations; infusion services experience preferred.
  • •Knowledge of insurance terminology, plan types, structures, and approval types.
  • •Previous experience with J-codes, CPT and ICD-10 coding; Athena experience a plus, but not required.
  • •Knowledge of medical terminology and clinical documentation review; strong organizational, detail-oriented, and multitasking abilities; able to think critically and make decisive judgments.
Experience:HealthcareMedical insuranceInfusion
Education:High School
Skills:OrganizationDetail-orientedMultitaskingCritical thinkingCommunication
Tech Stack:J-codesCPTICD-10Athena

Company Brief

Nira Medical
Nira Medical is a national neurology practice platform that partners with independent clinics to expand access to neurological care, infusion services, and clinical research, and to build real-world data resources for conditions like multiple sclerosis.
Industry: Healthcare Providers
Company Size: Medium (51 to 250 employees)
Headquarters: New York, United States
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