Clearance Specialist – Prior Authorization, Chronic Specialty Infusion

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

📋 Description

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

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

• Document coinsurance, copayments, deductibles, authorization requirements, and pertinent information.

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

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

• Review and gather clinical documents needed for authorization submissions.

• Communicate with patients, referral sources, departments, and other stakeholders regarding referral status, coverage, and updates.

• Guide or assist patients in enrolling in manufacturer copay assistance programs and/or foundations.

• Create initial patient start-of-care documentation.

• Execute additional duties as assigned.

• Work full-time from Monday to Friday, 8:30 a.m. to 5 p.m. Central Time.

⛳️ Requirements

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

• High school diploma or equivalent required.

• Solid understanding of Medicare, Medicaid, and managed care reimbursement policies.

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

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

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

• Familiarity with HIPAA regulations.

• Basic proficiency in Microsoft Excel and Word.

• Knowledge of CPR+ is preferred.

• Must be able to work remotely from the USA.

🏝️ Benefits

• 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