Clearance Specialist - Insurance Intake Coordinator

Accountabilities:

• Process new patient referrals, including insurance eligibility verification, test claim adjudication, coordination of benefits, and assessment of estimated patient financial responsibility.
• Perform detailed benefit verification for insurance plans, documenting coverage for medications, administration supplies, and related infusion services.
• Record and maintain accurate information regarding coinsurance, copayments, deductibles, authorization requirements, and other coverage conditions.
• Calculate estimated patient out-of-pocket responsibility based on verified benefits, payer contracts, and applicable self-pay pricing.
• Initiate, monitor, follow up on, and secure prior authorizations, pre-determinations, and medical reviews.
• Review clinical documentation and coordinate the collection of required materials for payer authorization submissions.
• Communicate with patients, referral sources, internal departments, and external stakeholders regarding referral status, coverage, authorization, and other updates.
• Assist patients who demonstrate financial need with enrollment in manufacturer copay assistance programs and applicable foundation resources.
• Generate new patient start-of-care documentation and ensure required intake information is completed accurately.
• Manage multiple referrals and competing priorities while maintaining productivity, quality, accuracy, and timely follow-up.
• Perform additional duties and assignments as needed to support intake and clearance operations.

Requirements

• At least 2 years of experience in home infusion specialty pharmacy intake is required.
• Hands-on experience with prior authorizations, insurance benefit verification, test claim processing, and HCPCS calculations.
• High school diploma or equivalent.
• Working knowledge of Medicare, Medicaid, and managed care reimbursement guidelines.
• Ability to interpret payer contract fee schedules using NDC and HCPCS units.
• Strong understanding of insurance coverage, authorization requirements, patient financial responsibility, and specialty pharmacy reimbursement processes.
• Knowledge of HIPAA regulations and the ability to handle patient information appropriately.
• Strong organizational and multitasking skills, with the ability to manage numerous referrals and competing priorities.
• Ability to maintain accuracy and productivity while working in a fast-paced environment.
• Strong communication and interpersonal skills when interacting with patients, referral sources, payers, and internal teams.
• Basic proficiency with Microsoft Excel and Word.
• Knowledge of CPR+ is preferred.
• Ability to work Monday through Friday from 8:30 a.m. to 5:00 p.m. Central Time.

Benefits

• Hourly compensation of $23–$27.
• Fully remote position within the United States.
• Full-time Monday–Friday schedule with no weekends or holidays.
• 401(k) plan with employer matching.
• Paid time off.
• 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 FSA.
• Education assistance program.
• Referral bonus opportunities.
• Annual merit-based increases.
• Opportunity to work in specialty pharmacy and complex infusion care.
• Collaborative and supportive workplace environment.