Specialty Pharmacy Intake & Authorization Coordinator

BHI, LLC•Farmers Branch, TX

1d•$25 - $30•Hybrid

About The Position

Basic Home Infusion (BHI) supports physicians in managing targeted drug delivery (TDD) patients and coordinating home infusion care. The Specialty Pharmacy Intake & Authorization Coordinator manages referrals, intake, insurance verification, and authorization processes for patients prescribed immunoglobulin therapies (IVIG and SCIG) and other specialty medications. The role serves as a liaison among prescribers, patients, payers, pharmacists, nursing teams, and manufacturer support programs to support timely therapy access and a seamless patient onboarding experience. The coordinator gathers clinical documentation, submits and tracks prior authorizations, coordinates financial assistance resources, and supports patient onboarding. The role is hybrid, with three days in the office. It requires strong knowledge of specialty pharmacy reimbursement processes, payer requirements, and immunoglobulin therapies. The position includes processing referrals; verifying insurance benefits and authorization requirements; submitting and tracking prior authorizations and appeals; coordinating financial assistance; communicating with patients and providers; coordinating therapy access and site-of-care requirements; and maintaining compliant, accurate documentation. The employee may be required to stand, sit, walk, see, hear, use hands and fingers, handle objects or controls, reach, bend, and lift, move, push, or pull equipment weighing up to 5 pounds frequently and up to 15 pounds occasionally. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Requirements

High school diploma or equivalent.
Experience with medical and pharmacy benefit investigations.
Knowledge of commercial, Medicare, and Medicaid insurance processes.
Strong understanding of prior authorization workflows.
Excellent verbal and written communication skills.
Strong organizational skills and ability to manage multiple referrals simultaneously.
Proficiency with pharmacy software, EMR systems, and Microsoft Office applications.

Nice To Haves

At least 2 years of healthcare reimbursement, specialty pharmacy, infusion, or prior authorization experience.
Experience supporting immunoglobulin (IG) and specialty medication therapies.
Home infusion or specialty infusion experience.
Knowledge of immunology, neurology, rheumatology, hematology, or rare disease therapies.
Familiarity with specialty pharmacy accreditation standards.
Experience with appeals, denials management, and payer escalation processes.
Understanding of specialty drug reimbursement and site-of-care optimization strategies.

Responsibilities

Receive, review, and process referrals for immunoglobulin (IG) and other specialty medication therapies.
Validate referral completeness, including prescriptions, clinical documentation, insurance information, and patient demographics.
Enter referral information into pharmacy management and reimbursement systems.
Prioritize referrals based on payer requirements, therapy urgency, and start-of-care timelines.
Contact provider offices to obtain missing documentation and clarify referral details.
Conduct insurance benefit verification for commercial, Medicare, Medicaid, and managed care plans.
Determine patient eligibility, coverage requirements, and authorization needs; verify preferred products, site-of-care restrictions, infusion requirements, and network participation.
Communicate patient financial responsibility and coverage information to internal stakeholders.
Prepare and submit prior authorization requests for immunoglobulin therapies, gathering supporting clinical documentation such as diagnoses, laboratory results, treatment history, and medical necessity documentation.
Monitor authorization status, follow up with insurance carriers, and coordinate peer-to-peer reviews and additional payer requirements.
Assist with denial management, reconsiderations, and appeals, and maintain detailed records of authorization activities and outcomes.
Identify patients who may benefit from manufacturer copay assistance or patient assistance programs, facilitate enrollment, explain support resources and financial obligations, and track enrollment and renewal requirements.
Serve as a primary point of contact during onboarding and provide timely updates to patients, providers, account managers, pharmacists, and clinical teams.
Educate patients about intake requirements, authorization status, and therapy initiation timelines.
Maintain professional relationships with physician offices, hospitals, clinics, and manufacturer support programs.
Collaborate with pharmacists, nursing teams, and scheduling departments to expedite therapy initiation.
Coordinate site-of-care requirements and payer-mandated treatment settings, and facilitate transitions among home infusion, infusion suites, or alternate care settings as required.
Ensure authorization requirements are met before scheduling services or dispensing therapy.
Maintain accurate, complete, and timely documentation in accordance with company policies.
Ensure compliance with HIPAA, state and federal regulations, and accreditation standards; participate in quality assurance, audit preparation, and accreditation activities; and protect confidential patient and healthcare information.