Intake Specialist- Infusion Pharmacy

Job Title: Intake and PA Coordinator - Infusion & Specialty Pharmacy (Parenteral Nutrition & DME Focus) with Billing Experience

Job Summary: We are seeking an experienced and highly qualified Intake and PA Coordinator to join our infusion pharmacy team, with a specific focus on parenteral nutrition (PN) and durable medical equipment (DME). PN is a covered DME benefit, and the ideal candidate will have expertise in handling prior authorizations (PA), billing, insurance processes, and insurance audit responses for both PN and DME therapies. The right candidate should have a solid background in infusion pharmacy or DME and a strong understanding of parenteral nutrition management. Experience in gastroenterology is a plus but not required. We are open to considering Certified Pharmacy Technicians (CPhT), Medical Assistants (MA), and LPNs with the appropriate experience. This position offers flexibility for remote or hybrid work arrangements, with a competitive salary based on experience.

Key Responsibilities

• Oversee the intake process for parenteral nutrition (PN) and DME services, ensuring accurate documentation is completed and processed efficiently.
• Coordinate and submit prior authorization (PA) requests for PN and DME therapies, ensuring full compliance with insurance guidelines and treatment protocols.
• Verify insurance coverage for PN and DME benefits, resolving any discrepancies or issues promptly.
• Work with the billing team to ensure accurate coding and billing for PN and DME products and services, including processing PN as a DME benefit.
• Respond to insurance audits related to PN and DME services, providing necessary documentation and supporting evidence to resolve issues and ensure reimbursement.
• Maintain accurate patient records within the pharmacy management system, ensuring compliance with all regulatory standards.
• Communicate effectively with patients, healthcare providers, and insurance companies to provide updates on PN therapy and DME equipment.
• Collaborate with clinical teams to ensure proper prescriptions for PN and DME therapies are processed and delivered on time.
• Provide patient education on the proper use of PN and DME products and offer ongoing support, including follow-up care and assistance with homecare services.
• Ensure timely delivery and setup of homecare services for PN and DME therapies, including equipment installation and patient education.

Required Qualifications

• Proven experience in infusion pharmacy, DME, or medical office settings, with a focus on parenteral nutrition and durable medical equipment.
• In-depth knowledge of insurance verification, prior authorization processes, and billing for PN and DME therapies.
• Experience in responding to insurance audits and providing necessary documentation to resolve discrepancies.
• Familiarity with infusion therapy protocols, parenteral nutrition management, and DME equipment.
• Strong organizational skills, with the ability to manage multiple tasks efficiently in a fast-paced environment.
• Excellent communication skills, with the ability to work effectively with patients, healthcare providers, and insurance companies.

Preferred Qualifications

• Certified Pharmacy Technician (CPhT), Medical Assistant (MA), or LPN credentials with relevant experience will be considered.
• Experience in parenteral nutrition and durable medical equipment (DME), including PN as a DME benefit.
• Knowledge of the prior authorization process and insurance audits for PN and DME therapies.
• Experience in gastroenterology or related specialties is a plus.

Work Environment

• In person ONLY
• Flexible hours based on operational needs.

Salary

• Commensurate with experience.

Application Instructions: Only highly qualified candidates will be considered for this position. If you have the necessary experience and meet the qualifications, please submit your resume and cover letter for consideration.