Specialty Clearance Specialist - Intake

Accountabilities: •

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

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

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

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

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

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

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

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

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

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

Requirements:

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High school diploma or equivalent.

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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.

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

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

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

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

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Basic proficiency in Microsoft Excel and Word.

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Familiarity with CPR+ is considered an advantage.

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

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

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

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

Benefits:

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

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Fully remote work opportunity within the United States.

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401(k) retirement plan with employer matching.

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Paid time off (PTO).

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No weekend or holiday shifts.

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Paid parental leave options.

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Affordable medical, dental, and vision insurance plans.

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Company-paid disability and basic life insurance.

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

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Employee referral bonus program.

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Annual merit-based salary increases.

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Education assistance program.

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Collaborative and supportive company culture.

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?

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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