IVX Health

General

• Review and Process Prior Authorizations – Thoroughly review Prior Authorization orders and ensure timely and accurate completion.
• Manage Clinical Documentation – Obtain and assess necessary clinical information such as medical history, diagnosis, and lab reports to support Prior Authorization submissions.
• Submit and Track Prior Authorizations – Follow criteria for medication approvals and accurately submit requests to insurance providers.
• Resolve Authorization Issues – Investigate and resolve outstanding medical documentation concerns and assist in resolving denied claims.
• Support Patients and Providers – Communicate effectively with patients, clinical staff, and insurance representatives regarding the Prior Authorization process.
• Ensure Compliance and Process Improvement – Stay up to date with evolving payer policies and identify ways to enhance workflow efficiency.
• Perform Additional Duties – Take on other responsibilities as assigned to support patient care and operational objectives.

Prior Authorization Coordinator

Account Specialist

• Serve as a key point of contact for patients regarding billing questions, payment plans, and account resolution
• Respond to inbound calls and proactively reach out to patients to collect past-due balances and arrange payments
• Review and explain Explanation of Benefits (EOBs) to patients in a clear and supportive manner.
• Run monthly patient statements and work closely with front office, insurance follow-up, and prior authorization teams to ensure smooth reimbursement workflows.
• Identify and assist patients with copay assistance programs, grants, and financial support resources.
• Maintain accurate, timely records while ensuring HIPAA compliance and Medicare guidelines.
• Support overall department goals by collaborating with internal teams to enhance the patient financial experience.

Patient Account Specialist

Operations

• Supervise insurance follow-up team members, set clear expectations, and drive productivity, quality, and documentation standards through coaching and performance management.
• Ensure timely follow-up on unpaid, underpaid, and denied claims. Monitor account activity for accuracy, compliance, and adherence to payer guidelines while reducing aged A/R.
• Act as the first level of escalation for complex account issues. Identify denial trends, reimbursement barriers, and systemic issues impacting collections performance.
• Partner with Prior Authorization, Credentialing, Coding, and Payment Posting teams to resolve discrepancies and remove barriers to reimbursement.
• Enforce adherence to billing workflows, payer requirements, HIPAA regulations, and internal policies while maintaining audit-ready documentation.
• Monitor team metrics, identify process gaps, and escalate opportunities for improvement to leadership. Adapt to evolving payer requirements and organizational priorities.
• Maintain oversight, productivity, and team engagement in a remote or hybrid setting while supporting onboarding and ongoing development.

Billing Operations Supervisor

Manager

• Lead and mentor the intake and prior authorization teams, ensuring an outstanding patient onboarding experience.
• Collaborate with local, regional, and national teams to drive process improvements and resolve issues effectively.
• Play a strategic role in onboarding new markets, working with leadership to develop a clear roadmap for success.
• Oversee training and development efforts to ensure your team is fully equipped to excel.
• Develop, review, and maintain intake processes, language, and training materials, ensuring compliance with company standards.
• Track performance, identify potential issues, and ensure that patient access functions run smoothly and efficiently.
• Conduct market and legislative research to stay ahead of trends and regulations in patient access and healthcare delivery.
• Manage and lead department-specific projects that support overall business goals.

Prior Authorization Coordinator

Patient Account Specialist

Billing Operations Supervisor

Manager, Prior Authorization, Pre-Registration