Specialty Clearance Specialist - Intake

Accountabilities:

• Process new patient referrals by verifying insurance eligibility, reviewing coverage, and coordinating benefits across multiple insurance plans.

• Perform benefit verifications for medications, administration supplies, and related infusion services, ensuring all coverage details are accurately documented.

• Review and document copayments, coinsurance, deductibles, prior authorization requirements, and other relevant reimbursement information.

• Run test claims and calculate estimated patient out-of-pocket expenses using insurance benefit information, payer contract fee schedules, and applicable self-pay pricing.

• Initiate, prepare, submit, and follow up on prior authorizations, predeterminations, and medical review requests to secure the necessary payer approvals.

• Review and obtain clinical documentation required for authorization submissions and reimbursement processes.

• Communicate referral status, insurance coverage, authorization updates, and other relevant information to patients, referral sources, and internal and external stakeholders.

• Identify patients who may need financial assistance and facilitate enrollment in manufacturer copay assistance programs or charitable foundations.

• Generate new patient start-of-care documentation and ensure accurate completion of intake paperwork.

• Maintain compliance with applicable healthcare privacy regulations and established operational procedures while meeting productivity and quality expectations.

Requirements:

• High school diploma or equivalent.

• At least 2 years of experience in home infusion or specialty pharmacy intake, with hands-on experience in prior authorizations, insurance benefit verification, test claim adjudication, and HCPCS calculations.

• Working knowledge of Medicare, Medicaid, and managed care reimbursement guidelines.

• Ability to interpret payer contract fee schedules using National Drug Codes (NDC) and Healthcare Common Procedure Coding System (HCPCS) units.

• Experience reviewing insurance coverage, calculating patient financial responsibility, and managing authorization requirements.

• Knowledge of HIPAA regulations and the importance of maintaining patient confidentiality.

• Basic proficiency in Microsoft Excel and Word.

• Familiarity with CPR+ is considered an advantage.

• Strong organizational and multitasking abilities, with the capacity to manage multiple referrals and competing priorities while maintaining accuracy and productivity.

• Excellent communication and interpersonal skills, with the ability to interact professionally with patients, healthcare providers, and internal teams.

• Ability to work independently in a fast-paced, deadline-driven environment while demonstrating attention to detail and accountability.

• Availability to work Monday through Friday, from 9:00 AM to 5:30 PM Eastern Time.

Benefits:

• Competitive hourly compensation of $23–$27 per hour.

• Fully remote work opportunity within the United States.

• 401(k) retirement plan with employer matching.

• Paid time off (PTO).

• No weekend or holiday shifts.

• Paid parental leave options.

• Affordable medical, dental, and vision insurance plans.

• Company-paid disability and basic life insurance.

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

• Employee referral bonus program.

• Annual merit-based salary increases.

• Education assistance program.

• Collaborative and supportive company culture.