Infusion Clearance Specialist – Insurance Coordinator

Job Description:

• Responsible for processing new referrals including but not limited to verifying patient eligibility, test claim adjudication, coordination of benefits, and identifying patient estimated out of pocket costs.
• Perform benefit verification of all patient insurance plans including documenting coverage of medications, administration supplies, and related infusion services
• Responsible to document all information related to coinsurance, copay, deductibles, authorization requirements, etc
• Calculate estimated patient financial responsibility based off benefit verification and payer contracts and/or company self-pay pricing
• Initiate, follow-up, and secure prior authorization, pre-determination, or medical review including reviewing and obtaining clinical documents for submission purposes
• Communicate with patients, referral sources, other departments, and any other external and internal customers regarding status of referral, coverage and/or other updates as needed
• Refer or assist with enrollment any patients who express financial necessity to manufacturer copay assistance programs and/or foundations
• Generate new patient start of care paperwork

Requirements:

• High school diploma or equivalent
• At least 2 years of home infusion specialty pharmacy and/or medical intake/reimbursement experience preferred
• Working knowledge of Medicare, Medicaid, and managed care reimbursement guidelines including ability to interpret payor contract fee schedules based on NDC and HCPCS units
• Strong ability to multi-task and support numerous referrals/priorities while ensuring productivity expectations and quality are met
• Ability to work in a fast-paced environment
• Knowledge of HIPAA regulations
• Basic level skill in Microsoft Excel & Word
• Knowledge of CPR+ preferred

Benefits:

• Competitive Wages
• 401(k) with a Match
• Referral Bonus
• Paid Time Off
• Great Company Culture
• Annual Merit Based Increases
• No Weekends or Holidays
• Paid Parental Leave Options
• Affordable Medical, Dental, & Vision Insurance Plans
• Company Paid Disability & Basic Life Insurance
• HSA & FSA (including dependent care) Options
• Education Assistance Program

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