Clearance Specialist, Insurance – Specialty Infusion

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

📋 Description

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

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

• Document coinsurance, copayments, deductibles, authorization requirements, and relevant insurance details.

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

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

• Review and gather clinical documents required for authorization submissions.

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

• Assist or refer patients to manufacturer copay assistance programs and foundations.

• Prepare new patient start-of-care documentation.

• Perform additional duties as assigned.

⛳️ Requirements

• 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.

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

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

• Capability 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.

• Availability to work Monday to Friday, from 9 AM to 5:30 PM Eastern Time.

🏝️ Benefits

• Competitive wages.

• 401(k) plan with a match.

• Referral bonuses.

• 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.