Prior Authorization Specialist

Job Summary

To support a Specialty Infusion Pharmacy, the full-time Clearance Specialist will manage new referrals, verify patient eligibility, and secure prior authorizations while working remotely.

Key responsibilities

• Perform benefit verification of patient insurance plans and document coverage details
• Calculate estimated patient financial responsibility based on benefit verification and payer contracts
• Initiate and follow up on prior authorization requests, ensuring all necessary clinical documents are submitted

Required qualifications

• At least 2 years of home infusion specialty pharmacy experience, including prior authorizations and benefit verifications
• High school diploma or equivalent
• Working knowledge of Medicare, Medicaid, and managed care reimbursement guidelines
• Basic proficiency in Microsoft Excel and Word
• Knowledge of HIPAA regulations