Patient Access Specialist – Specialty Infusion

SandsRx, LLC; United States; Remote; USD 45,000 - 65,000; Full time

Benefits offered by this job

Remote work-from-home

401(k) plan with employer matching

Paid vacation

Medical, dental, and vision insurance

Job summary

Sands Health is seeking an experienced Intake Specialist to join our specialty infusion team. This full-time role focuses on ensuring timely patient access by verifying insurance benefits, coordinating prior authorizations, onboarding patients, and assisting with copay and financial resources.

Ideal candidates have strong independent work habits and excellent communication. Healthcare experience, especially in benefits verification and infusion settings, is essential.

Qualifications

• Minimum of 2 years of experience in healthcare, medical billing, insurance benefit verification, patient access, or a related field.
• Experience with home infusion or ambulatory infusion centers is required.
• Specialty infusion experience, including IVIG and biologic therapies, is required.

Responsibilities

• Independently manage assigned patient referrals from initial receipt through onboarding.
• Enter and maintain accurate patient demographics, insurance, authorization, and other required information in the patient management system.
• Review prescriptions and referrals and attach them to patient profiles.
• Evaluate sites of administration based on patient needs and coverage.
• Coordinate with patients and physician offices to obtain required documentation.

Skills

Healthcare experience

Medical billing

Insurance verification

Prior authorization

Patient onboarding

Home infusion

IVIG/biologic therapies

Communication skills

Education

High school diploma or GED

Tools

Patient management system

Job description

Sands Health is seeking an experienced, motivated, and self-directed Intake Specialist to join our specialty infusion team.

This full-time position is responsible for facilitating timely patient access to prescribed medications and therapies through comprehensive insurance benefit verification, prior authorization coordination, patient onboarding, and copay and financial assistance support.

The ideal candidate demonstrates strong leadership, independence, accountability, proactive problem-solving, and exceptional communication skills. We are seeking an individual who takes ownership of assigned referrals, works effectively with minimal supervision, anticipates challenges, and independently drives tasks to completion.

The Intake Specialist must have in-depth knowledge of medical and pharmacy benefits, specialty infusion therapies, and insurance authorization processes while ensuring compliance with applicable federal and state regulations.

Health offers a competitive benefits package, including:

• Medical, dental, and vision insurance
• Long-term disability and life insurance
• Paid vacation
• 401(k) plan with generous employer matching
• Remote work-from-home opportunities
• Professional development and growth opportunities

Required Education and Experience

• High school diploma or GED required.
• Minimum of 2 years of experience in healthcare, medical billing, insurance benefit verification, patient access, or a related field.
• Experience with home infusion or ambulatory infusion centers is required.
• Specialty infusion experience, including IVIG and biologic therapies, is required.
• Strong understanding of medical and pharmacy insurance benefits, prior authorization requirements, and patient access processes.
• Demonstrated ability to independently manage multiple referrals, prioritize responsibilities, and meet deadlines.

Essential Duties and Responsibilities

1. Patient Intake and Referral Management

• Independently manage assigned patient referrals from initial receipt through completion of the intake and onboarding process.
• Enter and maintain accurate patient demographic, physician, insurance, authorization, and other required information in the patient management system.
• Review incoming prescriptions, referrals, and supporting documentation and attach them to new or existing patient profiles.
• Evaluate appropriate sites of administration, including home infusion and ambulatory infusion centers, based on patient needs, insurance coverage, and applicable requirements.
• Proactively identify missing information and coordinate with patients and physician offices to obtain required documentation.
• Monitor referral progress, identify potential delays, and take appropriate action to ensure timely processing.
• Maintain accountability for assigned referrals and ensure timely follow-through on outstanding tasks.

2. Insurance Benefit Verification and Prior Authorization

• Conduct comprehensive benefit investigations for new patient referrals, including evaluation of both medical and pharmacy benefit plans.
• Verify insurance eligibility, coverage, benefits, deductibles, copays, coinsurance, out-of-pocket responsibilities, and applicable coverage limitations.
• Identify payer-specific requirements, network restrictions, and authorization criteria.
• Obtain necessary clinical records, laboratory results, and supporting documentation from physician offices for prior authorization submissions.
• Initiate, coordinate, and follow up on prior authorization requests to facilitate timely determinations.
• Independently track pending authorizations, proactively follow up with payers, and address outstanding requirements without repeated reminders or supervision.
• Communicate authorization denials to physician offices and coordinate appropriate next steps, including peer-to-peer reviews, reconsiderations, and appeals.
• Identify in‑network or mandated pharmacy providers when insurance restrictions prevent service and coordinate appropriate referral disposition.
• Escalate complex coverage or reimbursement concerns when necessary, providing relevant findings and recommended solutions.

3. Patient Communication and Onboarding

• Proactively contact patients to initiate the onboarding process, conduct welcome calls, and establish effective communication.
• Explain the intake process, anticipated timelines, insurance requirements, and next steps in obtaining therapy.
• Confirm patient demographics, insurance information, treatment preferences, and other required information.
• Address patient questions and concerns related to insurance coverage, authorization status, and treatment access.
• Communicate estimated financial responsibilities, including deductibles, copays, and coinsurance, as appropriate.
• Maintain timely follow-up with patients throughout the intake process, particularly when additional information or action is required.
• Take ownership of patient communication and follow-up, ensuring that outstanding issues are addressed and patients remain informed of referral progress.
• Coordinate with Nursing, Pharmacy, and other departments to support a smooth transition from intake to treatment.

4. Copay and Financial Assistance Coordination

• Independently identify and coordinate available copay assistance and financial support programs for eligible patients.
• Evaluate potential eligibility for manufacturer copay programs, patient assistance programs, foundation assistance, and other available financial resources.
• Contact patients to explain financial assistance options, eligibility requirements, and enrollment processes.
• Obtain necessary patient information, signatures, financial documentation, and supporting paperwork.
• Assist patients with completing and submitting copay assistance and financial assistance applications.
• Communicate with manufacturers, program administrators, and other assistance organizations to facilitate enrollment.
• Proactively monitor application status, follow up on pending requests, and resolve enrollment barriers to minimize treatment delays.
• Communicate approval status, assistance limitations, and remaining patient financial responsibilities as appropriate.
• Maintain accurate documentation of financial assistance activities, communications, and enrollment outcomes.

5. Communication and Cross-Departmental Coordination

• Maintain professional and effective communication with patients, physicians, insurance companies, and internal departments.
• Provide regular and timely updates on referral status, benefit investigations, authorization requests, and outstanding requirements.
• Coordinate with Nursing, Pharmacy, Sales, and other departments to ensure seamless patient onboarding.
• Proactively communicate potential delays, barriers, or changes affecting patient access.
• Demonstrate strong interpersonal skills and the ability to resolve