Clearance Specialist – Benefits Verification Specialist

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

📋 Description

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

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

• Record information on coinsurance, copays, deductibles, authorization prerequisites, and other relevant insurance data.

• Calculate the anticipated financial responsibility of patients based on benefit verification, payer agreements, and/or the company’s self-pay pricing.

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

• Review and acquire clinical documents necessary for authorization submissions.

• Communicate with patients, referral sources, internal teams, and external stakeholders regarding the status of referrals and updates on coverage.

• Assist patients with enrollment in manufacturer copay assistance programs and foundations, or refer them as needed.

• Prepare new patient start-of-care documentation.

• Perform additional tasks as assigned.

⛳️ Requirements

• A minimum of 2 years of experience in home infusion specialty pharmacy, including prior authorizations, benefit verifications, test claims processing, and HCPC calculations.

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

• High school diploma or equivalent is necessary.

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

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

• Strong multitasking skills to manage multiple referrals and priorities while meeting productivity and quality standards.

• Capability to thrive in a fast-paced environment.

• Knowledge of HIPAA regulations is essential.

• Basic proficiency in Microsoft Excel and Word is required.

• Familiarity with CPR+ is preferred.

• Remote work from the USA is required.

• Must be available Monday to Friday, from 8:30 AM to 5 PM Central Time Zone.

🏝️ Benefits

• Competitive wages.

• 401(k) with a match.

• Referral bonuses.

• Paid time off.

• Positive company culture.

• Annual merit-based increases.

• No weekend or holiday work.

• Paid parental leave options.

• Affordable medical, dental, and vision insurance plans.

• Company-paid disability and basic life insurance.

• HSA and FSA options (including dependent care).

• Education assistance program.