Clearance Specialist

Job Summary

To support a Specialty Infusion Pharmacy, the full-time Clearance Specialist will work remotely, processing new referrals, verifying patient eligibility, and managing payer authorization requests while adhering to a schedule of Thursday to Monday from 8:30 AM to 5:00 PM Mountain Time.

Key responsibilities:

• Perform benefit verification of patient insurance plans and document coverage for medications and related services
• Calculate estimated patient financial responsibility based on benefit verification and payer contracts
• Initiate and secure prior authorizations and communicate with patients and referral sources regarding coverage updates

Required qualifications:

• High school diploma or equivalent
• At least 2 years of experience in home infusion specialty pharmacy or medical intake/reimbursement preferred
• Working knowledge of Medicare, Medicaid, and managed care reimbursement guidelines
• Basic proficiency in Microsoft Excel and Word
• Knowledge of HIPAA regulations and CPR+ preferred