Clearance Specialist – Intake Coordinator – Infusion

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

📋 Description

• The Clearance Specialist is tasked with handling new referrals, which includes verifying patient eligibility, adjudicating test claims, coordinating benefits, and determining estimated out-of-pocket costs for patients.

• Conduct benefit verification for all patient insurance plans, ensuring documentation of coverage for medications, administration supplies, and associated infusion services.

• Responsible for documenting all relevant information regarding coinsurance, copayments, deductibles, authorization requirements, and more.

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

• Initiate, follow up, and secure prior authorizations, pre-determinations, or medical reviews, which includes reviewing and collecting clinical documents for submission.

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

• Refer or assist patients who demonstrate financial need for enrollment in manufacturer copay assistance programs and/or foundations.

• Generate initial patient start of care documentation.

⛳️ Requirements

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

• High school diploma or equivalent is necessary.

• 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 and priorities while meeting productivity expectations and maintaining quality standards.

• Capability to thrive in a fast-paced environment.

• Familiarity with HIPAA regulations is essential.

• Basic proficiency in Microsoft Excel and Word is required.

• Knowledge of CPR+ is preferred.

🏝️ Benefits

• Competitive Wages

• 401(k) with a Match

• Referral Bonus

• Paid Time Off

• Great Company Culture

• Annual Merit-Based Increases

• No Weekends or Holidays

• Paid Parental Leave Options

• Affordable Medical, Dental, & Vision Insurance Plans

• Company Paid Disability & Basic Life Insurance

• HSA & FSA (including dependent care) Options

• Education Assistance Program