Clearance Specialist - Insurance Intake Coordinator
New
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JobgetherSpecialty Pharmacy
Based in United States, Monday through Friday from 8:30 a.m. to 5:00 p.m. Central TimeFull-TimeMiddle
Salary23 - 27 USD per hour
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Job Details
- Experience
- At least 2 years of experience in home infusion specialty pharmacy intake
- Required Skills
- Microsoft ExcelHIPAA
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.
Responsibilities
- 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.
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