Prior Authorization Specialist

About Our Company:
At Infinx, we're a fast-growing company focused on delivering innovative technology solutions to meet our clients' needs. We partner with healthcare providers to leverage automation and intelligence, overcoming revenue cycle challenges and improving reimbursements for patient care. Our clients include physician groups, hospitals, pharmacies, and dental groups.
We're looking for experienced associates and partners with expertise in areas that align with our clients' needs. We value individuals who are passionate about helping others, solving challenges, and improving patient care while maximizing revenue. Diversity and inclusivity are central to our values, fostering a workplace where everyone feels valued and heard.

A 2025 Great Place to Work®

In 2025, Infinx was certified as a Great Place to Work® in both the U.S. and India, underscoring our commitment to fostering a high-trust, high-performance workplace culture. This marks the fourth consecutive year that Infinx India has achieved certification and the first time the company has earned recognition in the U.S.

Location: Fully remote role with work hours 8am-5pm CT.

Summary Description:
Under general direction, this position is responsible for obtaining pre-certifications and pre-authorizations for procedures and medications, and could include scheduling appointments for outpatient testing with other providers, coordinates patient appointments/orders.

Daily Responsibilities:

• Obtain timely prior authorization or pre-determinations from all insurances, to include commercial plans, Medicaid, Medicaid and Medicare Advantage plans, following the company's established policies and protocols
• Selecting accurate and pertinent medical records from patients' charts from client's EMR
• Obtaining demographic information and verifying insurance information
• Provide all required clinical information to insurance companies necessary to facilitate the authorization process
• Perform complete documentation (within company software or client's EMR) on all prior authorizations follow-ups and determinations appropriately and in a timely manner
• Maintain and update internal listing of insurance carriers that require authorization, their processes, and phone and fax numbers
• Maintain the strictest confidentiality in accordance with HIPAA regulations and clinic requirements

Skills and Education:

• High School Diploma or GED as a basic qualification
• 2 years of experience working in a physician's office, pharmacy, or healthcare facility
• 2+ years of experience reviewing and processing prior authorization requests for cardiology, oncology, or genetic testing for multiple payers (Commercial, Medicare, Medicaid, marketplace plans)
• Strong computer literacy, including 2+ years of experience with Windows 11, Microsoft Office 365, Adobe Acrobat, proper phone etiquette, EMR/EHR systems, and a 43 wpm typing speed
• Ability to read, interpret, and apply medical terminology and clinical documentation
• Strong teamwork capabilities, self-motivation, and reliability
• Ability to multitask and work effectively in a high-volume, fast-paced, and deadline-driven environment
• Strong communication skills with the ability to interact with insurance companies via phone, fax, and electronic portals
• Ability to navigate insurance phone trees with ease
• Ability to work from 8am - 5pm Central
• Strong organizational skills and attention to detail
• Ability to maintain confidentiality and follow HIPAA regulations
• Problem-solving ability to investigate denials and determine next steps
• Comfortable navigating payer websites and electronic authorization systems

• Medical Assistant certification
• 5 years processing pre-determinations and insurance verification of benefits
• 5+ years working in a doctor's office or clinic and with medical terminology, payer portals, and TPA portals
• Ability to probe insurance representatives to obtain accurate authorization information
• 5+ years reading and interpreting clinical documentation
• 5+ years processing prior authorizations for genetic and molecular lab testing or cardiology/cardiovascular procedures
• Experience in Cerner EMR

Company Benefits and Perks:
Joining Infinx comes with an array of benefits, flexible work hours when possible, and a genuine sense of belonging to a dynamic and growing organization.

• Access to a 401(k) Retirement Savings Plan.
• Comprehensive Medical, Dental, and Vision Coverage.
• Paid Time Off.
• Paid Holidays.
• Additional benefits, including Pet Care Coverage, Employee Assistance Program (EAP), and discounted services.

If you are a dedicated and experienced PA Specialist ready to contribute to our mission and be part of our diverse and inclusive community, we invite you to apply and join our team at Infinx.