Clearance Specialist – Eligibility Representative

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

📋 Description

• Process new referrals, including the verification of patient eligibility.

• Conduct claim adjudication testing.

• Manage coordination of benefits.

• Identify estimated out-of-pocket costs for patients.

• Prepare, submit, and follow up on payer authorization requests.

• Perform benefit verification for all patient insurance plans.

• Document coverage for medications, administration supplies, and related infusion services.

• Record all information related to coinsurance, copays, deductibles, and authorization requirements.

• Calculate the estimated financial responsibility of patients based on benefit verification and payer contracts.

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

• Communicate with patients, referral sources, other departments, and both external and internal customers regarding the status of referrals, coverage, and other necessary updates.

• Refer or assist patients who indicate financial need in accessing manufacturer copay assistance programs and/or foundations.

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

⛳️ Requirements

• High school diploma or equivalent is required.

• Experience in running test claims and calculating HCPC codes is essential.

• Preferred: At least 2 years of experience in home infusion specialty pharmacy and/or medical intake/reimbursement.

• Working knowledge of Medicare, Medicaid, and managed care reimbursement guidelines, including the ability to interpret payer contract fee schedules based on NDC and HCPCS units.

• Strong multitasking abilities to manage numerous referrals/priorities while meeting productivity expectations and quality standards.

• Capability to work in a dynamic and fast-paced environment.

• Knowledge of HIPAA regulations is necessary.

• Basic proficiency in Microsoft Excel and Word.

• Preferred: Familiarity with CPR+ software.

🏝️ 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 shifts.

• Paid parental leave options.

• Affordable medical, dental, and vision insurance plans.

• Company-paid disability and basic life insurance.

• Options for HSA and FSA, including dependent care.

• Education assistance program.