Come join an exciting and innovative company that puts the “care” back in healthcare!
At KabaFusion, our patients come from all walks of life and so do we. We hire GREAT people, period! Our culture celebrates and supports the differences that make us unique. Here, it doesn’t matter what your role is, your hard work and dedication is not only recognized but celebrated. Join us and find out why this is the place to excel and do your best work.
About Us:
What started as a single pharmacy in 2010 has grown into KabaFusion becoming the largest privately held home infusion company in the country. We have a national network of pharmacies and nursing offices strategically placed to service 40+ states. Couple that with over 30 years of combined experience and it’s no wonder why KabaFusion is the industry leader in home infusion.
JOB SUMMARY:
This position is responsible for managing complex and high-risk eligibility, authorization, and financial assistance cases within home infusion services. This role specializes in escalations, second-level appeals, complex reimbursement issues, and challenging copayment assistance scenarios. In addition, this position plays a key role in removing payer and financial barriers to care, ensuring timely patient access to therapy while maintaining compliance with payer requirements and organizational standards.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
1. Manage escalated authorization cases involving complex payer requirements and non-standard scenarios.
2. Lead second-level appeals, including preparing detailed documentation, clinical justification, and payer communication.
3. Troubleshoot and resolve complex Revenue Cycle Management related issues tied to authorization, denials, and reimbursement barriers.
4. Manage challenging copayment assistance cases, including coordination with foundations, manufacturers, and internal teams.
5. Identify potential areas for retraining and support management and intake training team to implement a training plan.
6. Assist with covering intake, eligibility, and authorization workflows as needed.
7. Serve as the subject matter expert on authorization workflows, payer policies, and escalation pathways.
8. Work closely with intake, clinical, pharmacy, and billing teams to ensure seamless patient onboarding and continuity of care.
9. Proactively identify risks to authorization approval or reimbursement and implement mitigation strategies.
10. Assist with writing standard operating procedures, policies, information tools, and training tools.
11. Maintain accurate, thorough documentation in all systems to ensure compliance and audit readiness.
12. Identify trends in denials or escalation cases and recommend process improvements.
13. Assist with any projects that require authorization, copay assistance, demographic entry, or eligibility expertise.
14. Other related duties as assigned by manager or designee.
JOB REQUIREMENTS AND QUALIFICATIONS
Education:
- High school diploma or equivalent required.
- Associate or bachelor’s degree in health care of related field preferred.
Experience
- Minimum three (3) years of experience in healthcare authorizations, insurance verification, reimbursement, or revenue cycle operations, preferably in home infusion, specialty pharmacy, or a related healthcare setting.
- Experience managing prior authorizations, second-level appeals, and payer requirements for specialty therapies, infusion services, and high-cost medications.
- Knowledge of commercial, Medicare, and Medicaid payer guidelines, authorization processes, and reimbursement requirements.
- Working knowledge of HCPCS, CPT, and other applicable coding systems related to infusion and specialty pharmacy services.
- Experience obtaining authorizations and reimbursement for specialty, biologic, and high-cost medications.
- Understanding of revenue cycle management (RCM) processes and the impact of authorizations on reimbursement and claims outcomes.
- Experience navigating copay assistance, patient assistance, and other financial support programs for specialty therapy patients.
- Proficient experience with Microsoft Office including Word, Excel, PowerPoint, Outlook, Teams, and CPR+ software system or similar system preferred.
Skills and Competencies:
- Strong knowledge of prior authorization processes, payer guidelines, and coverage requirements across commercial, Medicare, and Medicaid plans.
- Ability to interpret insurance benefits, medical necessity criteria, coverage determinations, and complex payer policies to support successful authorization and appeal outcomes.
- Proven ability to manage complex or escalated authorization cases, including denials, appeals, and difficult approvals.
- Understanding of revenue cycle management (RCM) processes and the impact of authorizations on reimbursement and financial outcomes.
- Strong critical thinking, analytical, and problem-solving skills with the ability to identify barriers and develop effective solutions.
- Excellent verbal and written communication skills, including the ability to communicate effectively in highpressure or sensitive situations.
- Demonstrated ability to work independently, prioritize competing demands, and manage multiple cases simultaneously while maintaining accuracy and timeliness.
- Strong attention to detail and commitment to quality, compliance, and patient-centered service.
What we offer:
Competitive compensation
Benefits start on your 1st day of employment
401k w 4% match – no waiting or vesting period
PTO / Floating Holidays / Paid Holidays
Company paid life insurance, short term disability
Employee Assistance programs to help with mental health / wellness
Learning & Development Programs
Perks… includes discounts on travel, cell phone, clothing and more…
Generous employee referral program
To learn more about KabaFusion, please visit our careers page: https://www.kabafusion.com/careers/
Join us and find out why this is the place to excel and do your best work.
