Posted 9h ago•Remote - US
Prior Authorization Appeals Specialist
MiddleRemoteSalary undisclosed
Required Skills
Next.js
Job Description
Join Our Team at IVX Health!
IVX Health is seeking a Prior Authorization Appeals Specialist to provide specialized expertise in resolving complex pre-service authorization denials and appeals. This role works closely with providers, payers, Prior Authorization teams, and market partners to navigate payer requirements, coordinate supporting documentation, and help resolve barriers to patient access for medically necessary infusion and injection therapies. The ideal candidate brings strong knowledge of prior authorization and appeals processes, excellent problem-solving skills, and the ability to serve as a resource for complex cases and denial-related workflows.
What You'll Do
- Manage Denials & Appeals: Review pre-service authorization denials, determine appropriate next steps, and coordinate reconsiderations, appeals, peer-to-peer reviews, and payer exception requests within applicable timeframes.
- Navigate Payer Requirements: Interpret payer policies, medical necessity criteria, utilization management requirements, coverage guidelines, and denial rationales to determine appropriate resolution pathways.
- Coordinate Clinical Documentation:
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