Specialty Pharmacy Intake & Authorization Coordinator

Specialty Pharmacy Intake & Authorization Coordinator

Basic Home Infusion (BHI) supports physicians in managing their TDD patients—and your entire practice.

Today’s targeted drug delivery (TDD) and infusion therapies demand seamless coordination between physicians, care teams, and patients. BHI brings all three together—empowering doctors to extend care beyond the clinic, enabling staff to streamline and centralize management, and ensuring patients receive TDD in the comfort of their homes from experienced nurses.

BHI connects physicians, provider staff, and patients to deliver better home infusion.

Position Summary
We are currently hiring for a Specialty Pharmacy Intake & Authorization Coordinator who will be responsible for managing the referral, intake, insurance verification, and authorization processes for patients prescribed immunoglobulin therapies (IVIG and SCIG) and other specialty medications. This role serves as a critical liaison between prescribers, patients, payers, pharmacists, nursing teams, and manufacturer support programs to ensure timely access to therapy. This is a hybrid role with 3 days in office.

The coordinator is responsible for gathering clinical documentation, submitting and tracking prior authorizations, coordinating financial assistance resources, and facilitating a seamless patient onboarding experience. The ideal candidate possesses strong knowledge of specialty pharmacy reimbursement processes, payer requirements, and immunoglobulin therapies.

Essential Duties and Responsibilities

Intake & Referral Management

• Receive, review, and process referrals for 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.
• Communicate with provider offices to obtain missing documentation and clarify referral details.

Benefits Investigation

• Conduct comprehensive 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.
• Accurately communicate patient financial responsibility and coverage information to internal stakeholders. 

Prior Authorization & Appeals

• Prepare and submit prior authorization requests for immunoglobulin therapies.
• Gather and review supporting clinical documentation, including diagnosis information, laboratory results, treatment history, and medical necessity documentation.
• Monitor authorization status and proactively follow up with insurance carriers.
• Coordinate peer-to-peer review requests and additional payer requirements.
• Assist with denial management, reconsiderations, and appeals processes.
• Maintain detailed records of authorization activities and outcomes.

Financial Assistance Coordination

• Identify patients who may benefit from manufacturer copay assistance or patient assistance programs.
• Facilitate enrollment into available financial assistance programs.
• Educate patients regarding available support resources and financial obligations.
• Track program enrollment and renewal requirements.

Patient & Provider Communication

• Serve as a primary point of contact during the onboarding process.
• Provide timely updates to patients, providers, account managers, pharmacists, and clinical teams.
• Educate patients regarding intake requirements, authorization status, and therapy initiation timelines.
• Maintain professional relationships with physician offices, hospitals, clinics, and manufacturer support programs.

Therapy Access Coordination

• Collaborate with pharmacists, nursing teams, and scheduling departments to expedite therapy initiation.
• Coordinate site-of-care requirements and payer-mandated treatment settings.
• Facilitate transitions between home infusion, infusion suite, or alternate care settings as required.
• Ensure all authorization requirements are met before scheduling services or dispensing therapy.

Compliance & Documentation

• 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.
• Maintain confidentiality of patient and healthcare information. 

Required Qualifications

• High school diploma or equivalent required.
• 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.

Preferred Qualifications

• Minimum 2 years of healthcare reimbursement, specialty pharmacy, infusion, or prior authorization experience.
• Experience supporting 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.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• The employee may be frequently required to stand, sit, walk, see, hear; use hands and fingers regularly, handle, or feel objects, tools, or controls, reach with hands and arms, bend at the knees and waist - such as to access equipment.

• The employee may frequently lift and/or move, push and pull equipment, up to 5 pounds and may occasionally lift and/or move up to 15 pounds.

Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. This job description reflects management's assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned.

At Basic Home Infusion, we are deeply committed to promoting diversity, equity, and inclusion in our provision of intrathecal infusion pain management services. We recognize that these core values are essential for achieving optimal patient outcomes and creating a supportive and inclusive environment for our team members.