Specialty Clearance Specialist – Intake

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

📋 Description

• Process new referrals, which includes verifying patient eligibility, adjudicating test claims, coordinating benefits, and estimating out-of-pocket costs.

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

• Document information regarding coinsurance, copays, deductibles, authorization requirements, and related details.

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

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

• Review and obtain clinical documents for the purpose of submission.

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

• Refer or assist with enrollment in manufacturer copay assistance programs and foundations.

• Generate necessary start-of-care paperwork for new patients.

• Undertake additional duties as assigned.

⛳️ Requirements

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

• High school diploma or equivalent qualification is necessary.

• Familiarity with Medicare, Medicaid, and managed care reimbursement guidelines is essential.

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

• Strong multitasking abilities to manage numerous referrals and priorities while meeting productivity and quality expectations.

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

• Knowledge of HIPAA regulations is required.

• Basic proficiency in Microsoft Excel and Word.

• Knowledge of CPR+ is preferred.

• Must be available to work Monday to Friday, from 9 am to 5:30 pm Eastern Time.

🏝️ Benefits

• Competitive wages.

• 401(k) plan with a matching contribution.

• Referral bonus incentives.

• Paid time off policies.

• A positive company culture.

• Annual merit-based salary increases.

• No weekend or holiday shifts required.

• Options for paid parental leave.

• Affordable medical, dental, and vision insurance plans.

• Company-covered disability and basic life insurance.

• Health Savings Account (HSA) and Flexible Spending Account (FSA) options, including dependent care.

• Education assistance program available.