Infusion PA Coordinator

POSITION OVERVIEW

The Infusion Prior Authorization Coordinator plays a critical role in ensuring seamless access to infusion therapies for our members by managing the prior authorization process from initiation through approval. This position serves as the primary liaison between clinical teams, insurance providers, and specialty pharmacies to secure timely approvals for complex infusion treatments. The ideal candidate will combine strong analytical skills with exceptional attention to detail to navigate the complexities of insurance requirements while advocating for optimal member care within our integrated payvider model.

POSITION DUTIES & RESPONSIBILITIES

• Initiate, track, and manage prior authorization requests for all infusion therapies including specialty medications, biologics, and complex treatment protocols
• Review clinical documentation and treatment plans to ensure completeness and compliance with payer requirements
• Collaborate closely with physicians, nurse practitioners, and clinical staff to gather necessary clinical information and supporting documentation
• Communicate directly with insurance companies, specialty pharmacies, and third-party administrators to expedite approval processes
• Maintain detailed records of all prior authorization activities, including timelines, outcomes, and appeals processes
• Identify patterns in denial reasons and work with clinical and administrative teams to develop strategies for improved approval rates
• Coordinate with Harbor Health's internal utilization management team to align prior authorization activities with our payvider protocols
• Provide regular status updates to clinical teams and members regarding authorization progress
• Process appeals and peer-to-peer requests when initial authorizations are denied
• Stay current on changing payer policies, coverage criteria, and industry best practices for infusion therapies
• Support development of internal protocols to streamline the prior authorization workflow
• Assist with member education regarding their infusion therapy coverage and any cost-sharing responsibilities

DESIRED PROFESSIONAL SKILLS & EXPERIENCE

• Bachelor's degree preferred or equivalent combination of education and relevant experience
• Minimum 2-3 years of experience in prior authorization, utilization management, or pharmacy benefits coordination
• 3+ years experience in a clinical setting highly preferred
• Strong background in infusion therapies, specialty medications, and complex treatment protocols
• Experience working with specialty pharmacies and understanding of specialty drug distribution channels
• Proficient knowledge of insurance processes, medical coding (CPT, HCPCS, ICD-10), and clinical documentation requirements
• Excellent written and verbal communication skills with ability to interact professionally with clinical staff, payers, and external partners
• Strong organizational skills with ability to manage multiple concurrent cases and meet critical deadlines
• Experience with electronic health records (EHR) systems and prior authorization platforms
• Knowledge of Medicare, Medicaid, and commercial insurance coverage policies
• Ability to interpret clinical information and translate complex medical terminology for various stakeholders
• Problem-solving mindset with persistence in navigating challenging authorization scenarios
• Experience in healthcare startup or payvider environment strongly preferred
• Infusion Center experience preferred

WHAT WE OFFER

• Opportunity to directly impact member access to life-changing infusion therapies while helping shape Harbor Health's clinical operations
• Collaborative and dynamic work environment
• An organization made of people who are passionate about changing the healthcare landscape
• Competitive salary and benefits package
• Professional development and growth opportunities
• A transparent and unique culture