Acute Clearance Specialist – Insurance Intake

Jobtailor; Deutschland; Remote; EUR 42.000 - 59.000; Vollzeit

Zusammenfassung

Jobtailor in Germany seeks a detail-oriented Pharmacy Intake Specialist to manage referrals, verify benefits, and calculate patient financial responsibility for home infusion services.

You will coordinate prior authorizations, review clinical documents, and communicate with patients and providers while ensuring HIPAA compliance. Strong Excel/Word basics and knowledge of Medicare/Medicaid guidelines are essential.

Qualifikationen

• 2+ years in home infusion pharmacy with prior authorizations and benefit verification.

Aufgaben

• Process referrals and verify patient eligibility and coverage.
• Perform benefit verification for insurance plans including meds and infusion supplies.
• Document coinsurance, copays, deductibles, and authorization requirements.
• Calculate patient financial responsibility based on benefits and pricing.
• Initiate and follow up on prior authorizations and medical reviews.
• Review clinical documents for submission.
• Communicate status updates to patients and providers.
• Assist enrollment in copay assistance programs.
• Generate start-of-care paperwork.

Kenntnisse

Benefit Verification

Prior Authorizations

HCPCS Calculations

Patient Financial Responsibility

Test Claim Adjudication

Multi-tasking

Referral Management

Clinical Document Review

Ausbildung

High school diploma or equivalent

Tools

Microsoft Excel

Microsoft Word

CPR+

Jobbeschreibung

• Process new referrals, including verifying patient eligibility, test claim adjudication, coordination of benefits, and identifying estimated out-of-pocket costs
• Perform benefit verification for patient insurance plans, including medication, administration supplies, and infusion services coverage
• Document coinsurance, copays, deductibles, authorization requirements, and related information
• Calculate estimated patient financial responsibility based on benefit verification, payer contracts, and/or company self-pay pricing
• Initiate, follow up on, and secure prior authorizations, pre-determinations, and medical reviews
• Review and obtain clinical documents for submission
• Communicate with patients, referral sources, departments, and external and internal customers regarding referral status and coverage updates
• Refer or assist patients with enrollment in manufacturer copay assistance programs and foundations
• Generate new patient start-of-care paperwork

Requirements

• At least 2 years of home infusion pharmacy experience, including prior authorizations, benefit verifications, running test claims, and HCPC calculations
• Must be able to work full time, 40 hours per week, Monday-Friday
• Weekend on-call once every 4 weeks
• Experience with Acute Infusion for Prior authorization/Benefits Verification
• High school diploma or equivalent
• At least 2 years of home infusion specialty pharmacy medical intake/reimbursement experience required
• Working knowledge of Medicare, Medicaid, and managed care reimbursement guidelines
• Ability to interpret payor contract fee schedules based on NDC and HCPCS units
• Ability to multi-task and support numerous referrals/priorities while meeting productivity and quality expectations
• Ability to work in a fast-paced environment
• Knowledge of HIPAA regulations
• Basic level skill in Microsoft Excel & Word
• Knowledge of CPR+ preferred
• Must work 8:30am–5:00pm Central and be on-call once every 4 weeks

Core Competencies

Demonstrates expertise in home infusion pharmacy processes, including benefit verification, prior authorizations, and patient financial responsibility calculations. Proficient in managing referrals and communicating effectively with patients and healthcare providers while adhering to HIPAA regulations.

Highest-signal resume keywords

• Home Infusion Pharmacy Experience
• Prior Authorizations
• Benefit Verification
• Knowledge of Medicare and Medicaid Guidelines
• HCPCS Calculations

ATS Optimization Keywords

Hard Skills

• Benefit Verification
• Prior Authorizations
• HCPCS Calculations
• Patient Financial Responsibility Calculation
• Test Claim Adjudication
• Multi-tasking
• Referral Management
• Clinical Document Review

Soft Skills

• Communication
• Ability to Multi-task
• Adaptability in Fast-paced Environment

Industry Keywords

• Home Infusion
• Managed Care Reimbursement
• HIPAA Regulations
• Patient Eligibility
• Copay Assistance Programs

Tools & Technologies

• Microsoft Excel
• Microsoft Word
• CPR+