The role
This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Clearance Specialist - Insurance Intake Coordinator based in United States.
This role supports the intake and financial clearance process for patients receiving complex specialty infusion services. You’ll review new referrals, verify insurance benefits, process test claims, and assess patients’ estimated out-of-pocket responsibilities. The position also involves preparing and managing prior authorization, pre-determination, and medical review requests. You’ll work closely with patients, referral sources, payers, and internal teams to keep referrals moving efficiently toward care. Accuracy, organization, and strong knowledge of specialty pharmacy reimbursement are essential in this fast-paced environment. This is a fully remote opportunity for an experienced home infusion professional who wants to contribute directly to a smooth and patient-focused care journey.
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.
How Jobgether works:
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
We appreciate your interest and wish you the best!
Why Apply Through Jobgether?
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