Infusion Clearance Specialist – Insurance Coordinator

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

📋 Description

• Accountable for processing 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 medication coverage, administration supplies, and related infusion services.

• Responsible for documenting all pertinent information related to coinsurance, copayments, deductibles, authorization requirements, and more.

• Calculate the estimated financial responsibility of patients based on benefit verification and agreements with payers or the company's self-pay pricing.

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

• Communicate with patients, referral sources, various departments, and both internal and external stakeholders regarding the status of referrals, coverage, and any necessary updates.

• Refer or assist patients who indicate financial need towards manufacturer copay assistance programs or foundations.

• Create initial patient start of care documentation.

⛳️ Requirements

• A high school diploma or equivalent is required.

• A minimum of 2 years of experience in home infusion specialty pharmacy and/or medical intake/reimbursement is preferred.

• Familiarity with 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 maintaining productivity and quality standards.

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

• Knowledge of HIPAA regulations is essential.

• Basic proficiency in Microsoft Excel and Word.

• Familiarity with CPR+ is preferred.

🏝️ Benefits

• Competitive wages.

• 401(k) with matching contributions.

• Referral bonus program.

• Paid time off.

• Positive company culture.

• Annual merit-based salary increases.

• No weekend or holiday work required.

• Paid parental leave options available.

• Affordable medical, dental, and vision insurance plans.

• Company-funded disability and basic life insurance.

• Options for Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA), including dependent care.

• Education assistance program.