Specialty Clearance Specialist - Intake
Core
Coordinate patient referrals and ensure timely access to specialty infusion therapies by managing insurance verification, benefit assessments, prior authorizations, and reimbursement processes.
Role type
Specialty clearance specialist (intake)
Builds
Patient onboarding for specialty infusion therapies
Domain
Healthcare / Specialty pharmacy / Home infusion
Deliverable
client delivery
Required skills
Insurance verification, benefit assessment, prior authorization management, reimbursement process coordination, clinical documentation review, patient communication, payer contract analysis
Preferred skills
Home infusion and specialty pharmacy reimbursement expertise
Responsibilities
Process new patient referrals by verifying insurance eligibility and coordinating benefits; Perform benefit verifications for medications, administration supplies, and infusion services; Review and document copayments, coinsurance, deductibles, and prior authorization requirements; Run test claims and calculate estimated patient out-of-pocket expenses; Initiate and follow up on prior authorizations and medical review requests; Review and obtain clinical documentation required for authorization submissions.