Job Summary

A healthcare company providing specialized therapy management programs is filling a position for a Remote Medical Clearance Specialist.

Candidates will be responsible for the following:

• Receiving medication referrals and collects insurance information via multiple methods, running test claims, and completing administrative duties
• Contacting referral source, patient, and/or doctor’s office to obtain additional information that is required to complete verification of benefits
• Verifying and documenting insurance coverage of medications, administration supplies, and related pharmacy services including prior authorization requirements and coordination of benefits

Must meet the following requirements for consideration:

• Previous specialty infusion clearance experience with immune globulin products and specialty therapies
• At least 2 years of experience applying knowledge of Medicare, Medicaid, and Managed Care coverage and reimbursement guidelines
• Previous medical and pharmacy benefits verification experience
• Ability to interpret payor contract fee schedules based on NDC and HCPCS units
• Ability to effectively handle multiple priorities within a changing environment
• Experience in diagnosing, isolating, and resolving complex issues and recommending and implementing strategies to resolve problems