Strong communication and active listening skills
Ability to handle sensitive information with confidentiality
Organizational and time management skills
Cultural competence and informed speech
Proficiency in Microsoft Office and EMR billing systems
Ability to work in a fast-paced environment
Ability to de-escalate patients to effectively communicate
Ability to stay focused and committed and follow through on actions needed
High attention to detail
Patient-focused mindset with strong customer service skills
Key ResponsibilitiesReferral & Intake Processing
Receive and process infusion and specialty pharmacy referrals from providers offices and your assigned Marketers.
Review referrals for completeness, including clinical documentation, prescriptions, and supporting records
Enter and maintain accurate patient demographics, insurance information, and therapy details into EMR/Pharmacy Management System.
Schedule patients for infusion services in coordination with nursing, pharmacy, and clinical teams
Ensure Marketers are notified within 2 hours of receiving the initial referral after benefits have been reviewed
Monitor intake metrics and assist with reporting as needed Benefits Investigation & Authorization Support
Perform or support insurance benefits verification for infusion therapies and specialty medications
Identify coverage requirements, prior authorization needs, and payer-specific documentation
Communicate authorization status, delays, or issues to internal teams and referral sources
Track and follow up on pending authorizations to support timely therapy initiation
Review current patients monthly to ensure that PAs are not due to expire
Ensure benefits and prior-auth's are verified for the correct HCPC codes and any alternatives, supplies, etc.
Complete Analysis template when needed to serve as information to management when additional reviews are needed to determine patient status
Verify primary and secondary insurance coverage
Escalate denials and collaborate with management timely to avoid delays Client, Patient & Provider Communication
Serve as a primary point of contact for patients, caregivers, and referral sources during the entire intake process
Serve as a primary resource for up to date and status of pending patients at any given time.
Provide clear, compassionate communication regarding next steps, scheduling, and documentation needs
Communicate coverage outcomes to patients, providers and assigned marketers
Address intake-related concerns or escalations within defined scope and document appropriately
Provide clear, concise and accurate information to patients regarding referral status, copays and patient responsibility
Educate patients on their enrolled government and/or medical benefits, coinsurance, OOP, Deductibles and all information related to benefits when needed.
Provide clear explanations of services, timelines and expectations to patients and provider offices
Obtain patient consent when necessary
Collaboration with Pharmacy & Infusion Operations
Coordinate closely with pharmacy staff to ensure prescriptions align with referral and payer requirements
Coordinate with staff on refill patients to ensure copays are correctly entered and updated as needed and patients are scheduled timely to avoid appointment delays
Communicate therapy start dates, changes, or delays to nursing and pharmacy teams
Communicate to marketers and/or Provider offices when additional information is needed to process a referral
Partner with reimbursement, billing, and clinical teams to ensure accurate handoffs and continuity of care Process Support & Quality Assurance
Follow established intake, pharmacy, and infusion workflows to ensure compliance with regulatory and payer requirements
Participate in audits and quality checks related to intake accuracy, documentation, and turnaround times Required Qualifications
High school diploma or equivalent (Associate or Bachelor's degree preferred in healthcare-related field).
2+ years' experience in: o Home Infusion o Specialty Pharmacy o Pharmacy Benefits o Medical insurance verification
Knowledge of Medicare, Medicaid and commercial payer guidelines
Experience with prior authorizations and benefit investigation
Proficiency with EMR systems and pharmacy management software
Strong understanding of medical terminology Preferred Qualifications
Certified Medical Coding Certificate or degree
Experience with specialty medications (biologics, IVIG, TPN, oncology supportive care, etc.)
Knowledge of reimbursement models (Part B vs.

Part D, buy and bill vs. pharmacy benefit)

Pay:

From $26.00 per hour

Benefits:

401(k) Health insurance Paid time off

Work Location:

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