*Chronic Specialty Infusion experience is required (IVIG, Neurology and Immunology/Rheumatology)*
*Hemophilia experience is preferred*
*Experience in home infusion pharmacy is required*
*Remote position*
The Referral & Authorization Specialist is responsible for providing support to a clinical, intake and verification team in order to facilitate the administrative components of referrals.
Primary duties may include, but are not limited to:
- Verifying eligibility and benefits for medical and pharmacy payers through multiple methods for specialty chronic therapy services.
- Acts as liaison between patients, healthcare providers, infusion centers, pharmacy, and billing department to address issues.
- Review and interpret clinical records to ensure patient meets medical policy guidelines for coverage, for completeness, and performs follow-up for additional information if necessary.
- Initiate pre-determination, prior authorizations, and appeals for denials based on payer policy.
- Ability to read and interpret payer contracts, and payer policies to effectively manage referrals and mitigate risk of accounts receivable.
- Maintain knowledge of therapies serviced by SandsRx
- Contacts physician offices as needed to obtain demographic information or related data.
- Manage referrals, documents communications, actions, and other data in the system.
Requirements:
- HS diploma or GED and a minimum of 2 years of experience in healthcare reimbursement, billing, or patient access, with specific experience in specialty chronic infusion therapy (Neurology specialty biologics, Immune Globulin therapy, Hemophilia)
- Advanced knowledge of HCPCS, NDC, CPT, and ICD-10 coding for referral management.
- Knowledge of insurance verification and pre-authorization.
- Experience in specialty home infusion pharmacy or infusion centers is required
Preferred Skills, Capabilities, & Experiences:
- Knowledge of claims submission is preferred.
- Strong mathematical, analytical, and problem-solving skills.
- Proficiency in computer skills, including electronic health record systems and Microsoft Office suite.
- Ability to work independently and collaboratively.
- Ability to maintain professionalism and confidentiality.
- Enjoys working in a team-oriented, service-focused environment.
- Demonstrate extreme attention to detail and accuracy.
- Ability to prioritize and meet deadlines.
Job Type: Full-time
Pay: From $23.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Experience:
- Chronic Specialty Infusions: 1 year (Required)
- Prior Authorizations and medical criteria: 2 years (Required)
- Home infusion pharmacy or infusion center: 1 year (Required)
Location:
- Texas (Preferred)
Work Location: Remote