Prior Authorization Specialist

Behind every approved infusion treatment is a Prior Authorization Specialist who navigated payer policy, step therapy requirements, and paperwork so the patient never had to. We're looking for someone who thrives on solving that puzzle quickly and accurately.

Why This Role Feels Different

This isn't a repetitive data-entry job. Every case is its own investigation, requiring you to interpret clinical documentation, understand payer policy, and figure out exactly what it will take to get a patient's treatment approved. You'll manage a real caseload of active authorizations, work across systems like Salesforce, WeInfuse, and AMD, and collaborate daily with providers, clinical teams, and internal stakeholders to keep cases moving. The work you do directly determines how quickly patients get the treatment they need. If you like being the person who cracks the case and gets things unstuck, this role gives you that challenge every day.

The Job

The Prior Authorization Specialist is a vital team member responsible for efficiently managing the prior authorization process to ensure seamless patient care and timely treatment. This role requires a solid understanding of medical benefits, step therapy, and authorization policies, along with exceptional organizational, communication, and problem-solving skills. You will manage a caseload of at least 30 active authorizations and skillfully navigate systems such as Salesforce, WeInfuse, and AMD to track and update case progress, send communications, and meet critical deadlines. This role is key to maintaining operational efficiency and directly contributes to Pure Infusion's standard of excellence and patient satisfaction.

Key Responsibilities

• Process prior authorizations accurately and efficiently, including reviewing step therapy, minimum authorization requirements, and payer-preferred medications.
• Manage appeals and denials, escalating cases when necessary, and follow appropriate payer protocols.
• Analyze insurance policies for each case and communicate with internal teams or providers to obtain needed documentation when a case does not align with policy.
• Verify insurance benefits and determine in-network (INN) or out-of-network (OON) status across various payers and states under Intake standards.
• Evaluate medical and pharmacy benefits to determine patient eligibility for treatment.
• Maintain clear, professional communication with providers, patients, internal teams, and stakeholders.
• Accurately document all case-related conversations and updates within Salesforce within required timeframes.
• Prioritize personal tasks and authorizations to ensure timely completion and follow-up.
• Collaborate with internal team members, including PACs, clinical staff, and sales, to gather or clarify case information.
• Investigate and resolve complex cases using strong critical thinking and problem-solving skills.
• Organize and manage authorization workload efficiently to meet performance goals.
• Follow Intake standards for accuracy and completion.

The Ideal Candidate

We are looking for someone who is highly organized, detail oriented, and energized by solving complex cases. Ideal candidates will:

• Bring proven ability to interpret clinical documentation and understand commercial and Medicare Advantage policies, including Local Coverage Determinations (LCDs).
• Communicate clearly and professionally with both clinical teams and patients.
• Manage multiple priorities confidently in a fast-paced environment.
• Bring strong documentation habits and time management skills.

Required Qualifications

• Minimum 2-3 years of experience as a Medical Assistant (MA), with direct prior authorization and biologic therapy experience.
• Strong experience working with systems like Salesforce, WeInfuse, and AMD.
• High School diploma or equivalent required.
• Certification or formal training as a Medical Assistant required.
• Biologic authorization experience required.
• Proficiency with EMRs, CRMs (Salesforce), and prior authorization systems.
• Comfortable working in software like a PMS or EMR to track information, schedule, and make notes.
• Ability to meet U.S. employment and eligibility requirements.

Preferred Qualifications

• Background in a specialty field such as Rheumatology, Gastroenterology, Dermatology, Neurology, or Immunology preferred.

Why Join Pure Infusion?

At Pure Infusion, you will find a role where your work matters in a direct and personal way. You will be part of a team that is building a better healthcare experience for patients, providers, and employees. If this resonates with you, we would love to meet you. Thank you for considering a career with Pure Infusion. We look forward to the opportunity to work together.