Authorization Specialist III

TwelveStone Health Partners Inc • Murfreesboro, TN

13d • Onsite

About The Position

We are currently hiring for the position of full-time Authorization Specialist III based out of Corporate office location in Murfreesboro, TN. This position serves as a subject matter expert, collaborating with referral sources, insurance providers, and internal teams to ensure timely and accurate authorization, dispensing, and billing of patient care. The role also includes intake responsibilities such as verifying insurance, determining billing avenue, and communicating with patients regarding their referrals and coverage.

Requirements

• High School Diploma or GED required.
• 2+ years of experience in medical intake, pharmacy authorization, or healthcare office settings.
• Experience with specialty/IV pharmacy, HCPC coding, ICD-10, EMR systems, and insurance portals.
• Proven ability to work in high-productivity environments with performance metrics.
• Attention to detail, critical thinking, problem solving, verbal and written communication, teamwork, collaboration, initiative, follow-through, multitasking, phone etiquette, dependability, and ability to work independently.

Nice To Haves

• Pharmacy Technician License (PT), CPhT certification, or professional license (LPN, Medical Assistant, etc.)

Responsibilities

• Handle complex and urgent authorization requests and issues, including denials and appeals.
• Prepare and submit appeal documentation and follow up with payers to ensure resolution.
• Obtain and review clinical information (e.g., medical history, diagnosis, labs) for completeness and compliance.
• Initiate and manage prior medical/pharmacy authorization requests, following criteria and submitting to insurance companies.
• Verify insurance coverage and ensure documentation meets payer requirements.
• Manage communication via phone, email, fax, and web portals with referral sources, insurance providers, and internal departments
• Other duties as assigned

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED