- Process new referrals, including verifying patient eligibility, test claim adjudication, coordination of benefits, and identifying estimated out-of-pocket costs
- Perform benefit verification for patient insurance plans, including medication, administration supplies, and infusion services coverage
- Document coinsurance, copays, deductibles, authorization requirements, and related information
- Calculate estimated patient financial responsibility based on benefit verification, payer contracts, and/or company self-pay pricing
- Initiate, follow up on, and secure prior authorizations, pre-determinations, and medical reviews
- Review and obtain clinical documents for submission
- Communicate with patients, referral sources, departments, and external and internal customers regarding referral status and coverage updates
- Refer or assist patients with enrollment in manufacturer copay assistance programs and foundations
- Generate new patient start-of-care paperwork
Requirements
- At least 2 years of home infusion pharmacy experience, including prior authorizations, benefit verifications, running test claims, and HCPC calculations
- Must be able to work full time, 40 hours per week, Monday-Friday
- Weekend on-call once every 4 weeks
- Experience with Acute Infusion for Prior authorization/Benefits Verification
- High school diploma or equivalent
- At least 2 years of home infusion specialty pharmacy medical intake/reimbursement experience required
- Working knowledge of Medicare, Medicaid, and managed care reimbursement guidelines
- Ability to interpret payor contract fee schedules based on NDC and HCPCS units
- Ability to multi-task and support numerous referrals/priorities while meeting productivity and quality expectations
- Ability to work in a fast-paced environment
- Knowledge of HIPAA regulations
- Basic level skill in Microsoft Excel & Word
- Knowledge of CPR+ preferred
- Must work 8:30am–5:00pm Central and be on-call once every 4 weeks
Core Competencies
Demonstrates expertise in home infusion pharmacy processes, including benefit verification, prior authorizations, and patient financial responsibility calculations. Proficient in managing referrals and communicating effectively with patients and healthcare providers while adhering to HIPAA regulations.
Highest-signal resume keywords
- Home Infusion Pharmacy Experience
- Prior Authorizations
- Benefit Verification
- Knowledge of Medicare and Medicaid Guidelines
- HCPCS Calculations
ATS Optimization Keywords
Hard Skills
- Benefit Verification
- Prior Authorizations
- HCPCS Calculations
- Patient Financial Responsibility Calculation
- Test Claim Adjudication
- Multi-tasking
- Referral Management
- Clinical Document Review
Soft Skills
- Communication
- Ability to Multi-task
- Adaptability in Fast-paced Environment
Industry Keywords
- Home Infusion
- Managed Care Reimbursement
- HIPAA Regulations
- Patient Eligibility
- Copay Assistance Programs
Tools & Technologies
- Microsoft Excel
- Microsoft Word
- CPR+
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Acute Clearance Specialist – Insurance Intake Arbeitgeber: Jobtailor
Als Front Office Supervisor in unserem dynamischen Team bieten wir Ihnen die Möglichkeit, in einem unterstützenden und freundlichen Arbeitsumfeld zu wachsen. Wir legen großen Wert auf die berufliche Entwicklung unserer Mitarbeiter und bieten regelmäßige Schulungen sowie die Chance, Verantwortung zu übernehmen. Unsere Lage ermöglicht es Ihnen, Teil einer lebendigen Gemeinschaft zu sein, während Sie gleichzeitig die Standards unseres Franchise-Partners einhalten und unseren Gästen einen unvergesslichen Aufenthalt bieten.
