Acute Clearance Specialist – Insurance Intake

This is a fully remote position, open to applicants in Texas.

📋 Description

• Manage new referrals by verifying patient eligibility, adjudicating test claims, coordinating benefits, and estimating out-of-pocket costs.

• Conduct benefit verification for patient insurance plans, covering medication, administration supplies, and infusion services.

• Record details regarding coinsurance, copays, deductibles, authorization prerequisites, and other relevant information.

• Assess estimated patient financial obligations based on benefit verification, payer contracts, and/or internal self-pay pricing.

• Initiate and follow up to secure prior authorizations, pre-determinations, and medical reviews.

• Review and gather clinical documents for submission purposes.

• Communicate with patients, referral sources, departments, and both internal and external stakeholders about referral statuses and coverage updates.

• Guide or assist patients in enrolling in manufacturer copay assistance programs and foundations.

• Create start-of-care paperwork for new patients.

⛳️ Requirements

• Minimum of 2 years’ experience in home infusion pharmacy, including prior authorizations, benefit verifications, test claims, and HCPC calculations.

• Availability to work full time, 40 hours per week, from Monday to Friday.

• On-call availability during weekends once every 4 weeks.

• Experience with Acute Infusion for prior authorization and benefits verification.

• High school diploma or equivalent is necessary.

• At least 2 years of experience in home infusion specialty pharmacy medical intake/reimbursement is required.

• Familiarity with Medicare, Medicaid, and managed care reimbursement guidelines is essential.

• Ability to interpret payer contract fee schedules based on NDC and HCPCS units.

• Capable of multi-tasking and managing various referrals/priorities while achieving productivity and quality standards.

• Ability to thrive in a fast-paced work environment.

• Knowledge of HIPAA regulations is required.

• Basic proficiency in Microsoft Excel and Word is necessary.

• Familiarity with CPR+ is preferred.

• Must be available to work from 8:30 am to 5:00 pm Central time and be on-call once every 4 weeks.

🏝️ Benefits

• Competitive wages.

• 401(k) plan with a match.

• Referral bonus program.

• Paid time off.

• Positive company culture.

• Annual merit-based increases.

• No weekend or holiday work required.

• Options for paid parental leave.

• Affordable medical, dental, and vision insurance plans.

• Company-paid disability and basic life insurance.

• HSA and FSA options available, including for dependent care.

• Education assistance program.