Infusion Benefit Coordinator – Clearance Specialist

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

📋 Description

• Accountable for processing new referrals, which includes verifying patient eligibility, adjudicating test claims, coordinating benefits, and identifying estimated out-of-pocket costs for patients.

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

• Responsible for documenting all relevant information related to coinsurance, copays, deductibles, authorization requirements, and other necessary details.

• Calculate estimated patient financial responsibilities based on benefit verification and payer contracts or company self-pay pricing.

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

• Communicate with patients, referral sources, other departments, and any relevant external and internal customers regarding referral status, coverage, and any necessary updates.

• Refer or assist patients expressing financial need with enrollment in manufacturer copay assistance programs or foundations.

• Generate new patient start of care documentation.

• Additional duties as assigned.

⛳️ Requirements

• Experience in infusion benefit verification and prior authorization is required.

• Proficiency in running test claims and calculating HCPC codes is mandatory.

• High school diploma or equivalent is necessary.

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

• Strong capability to multitask and manage multiple referrals/priorities while meeting productivity expectations and quality standards.

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

• Knowledge of HIPAA regulations is essential.

• Basic proficiency in Microsoft Excel and Word is required.

• Familiarity with CPR+ is preferred.

🏝️ Benefits

• Competitive wages.

• 401(k) with a match.

• Referral bonus.

• Paid time off.

• Positive company culture.

• Annual merit-based increases.

• No weekends or holidays.

• Paid parental leave options.

• Affordable medical, dental, and vision insurance plans.

• Company-paid disability and basic life insurance.

• HSA and FSA options (including dependent care).

• Education assistance program.