Clearance Specialist – Insurance Intake Coordinator

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 out-of-pocket expenses.

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

• Record information regarding coinsurance, copays, deductibles, authorization requirements, and related details.

• Calculate the estimated financial responsibility for patients based on benefit verification, payer contracts, and/or company self-pay pricing.

• Initiate, monitor, and obtain prior authorization, pre-determination, or medical review as necessary.

• Review and gather clinical documents needed for authorization submissions.

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

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

• Prepare new patient start-of-care documentation.

• Carry out additional duties as assigned.

⛳️ Requirements

• A minimum of 2 years of experience in home infusion specialty pharmacy intake is required.

• High school diploma or equivalent is necessary.

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

• Proficiency in interpreting payor contract fee schedules based on NDC and HCPCS units.

• Strong multitasking abilities to manage various referrals and priorities while meeting productivity and quality expectations.

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

• Knowledge of HIPAA regulations is important.

• Basic proficiency in Microsoft Excel and Word is required.

• Familiarity with CPR+ is preferred.

• Must be available to work Monday through Friday, from 8:30 AM to 5:00 PM Central Time Zone.

🏝️ Benefits

• Competitive wages.

• 401(k) with matching contributions.

• Referral bonuses.

• Paid time off.

• Positive company culture.

• Annual merit-based salary 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 Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA), including dependent care.

• Education assistance program.