Clearance Specialist - Insurance Intake Coordinator

United StatesRemoteFull-timemid

OtherIntake Coordinator

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Quick Summary

Overview

This position is listed on behalf of a partner company, who manages all applications and next steps.

Technical Tools

OtherIntake Coordinator

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.

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

~1 min read

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.