About the Role
This role is responsible for facilitating patient access to prescribed home infusion therapies by coordinating insurance verification, benefits investigation, and financial support. The specialist ensures accurate documentation and timely processing to support seamless therapy initiation.
Responsibilities
- Verify patient insurance coverage for prescribed infusion medications
- Investigate patient benefits and coverage limitations
- Communicate with insurance providers to resolve coverage questions
- Assist in obtaining prior authorizations for therapy
- Identify financial assistance options for eligible patients
- Coordinate with pharmacy and clinical teams to confirm therapy details
- Ensure accurate and timely data entry into case management systems
- Follow up on outstanding insurance requests or denials
- Educate patients and caregivers on insurance and payment processes
- Maintain compliance with privacy and regulatory standards
- Track and report case status updates
- Collaborate with prescribing physicians to secure necessary documentation
- Support appeals for denied claims when appropriate
- Monitor turnaround times for access processes
- Respond to internal inquiries about patient access status
- Use electronic systems to manage patient cases
- Ensure all required forms are completed and submitted
- Stay current on payer policies and changes
- Assist in onboarding new patients to therapy programs
- Document all patient interactions accurately
- Escalate complex cases to supervisors as needed
- Participate in team meetings and training sessions
- Adhere to departmental performance metrics
- Support quality improvement initiatives
- Maintain professional communication with all stakeholders
Work Arrangement
Remote
Team
Part of a specialized pharmacy services team focused on patient support and medication access
About the Role
This position plays a key role in connecting patients with prescribed infusion therapies by managing access barriers. The specialist works remotely to coordinate insurance and financial support, ensuring patients can begin treatment without delays.
What You Will Do
- Conduct insurance verification and benefits assessment
- Secure prior authorizations with provider offices
- Guide patients through financial assistance applications
- Update case records in a timely manner
- Collaborate with internal teams to resolve access issues
Required Qualifications
- High school diploma or GED
- Minimum 1 year of experience in healthcare, pharmacy, or customer service
- Proficiency in electronic documentation systems
- Strong communication and organizational skills
Preferred Qualifications
- Degree in health-related field
- Experience in specialty pharmacy or home infusion
- Familiarity with prior authorization software
- Knowledge of CPT and HCPCS coding
Work Environment
- Fully remote position with secure system access
- Standard business hours with occasional flexibility
- Regular virtual team collaboration
- Performance measured by accuracy and timeliness
Physical Requirements
- Sedentary work at a computer for extended periods
- Frequent typing and phone communication
- Ability to maintain focus during repetitive tasks
Equal Employment Opportunity
- Employment decisions are based on merit, qualifications, and business needs
- No discrimination based on race, gender, religion, or other protected status
Background Check
Position requires a criminal background check and reference verification
Drug Screening
Pre-employment drug screening is required for this role
Immunization Policy
Must comply with organization's vaccination requirements
Not available
