Specialty Admissions Coordinator / Remote
About the position The Specialty Admission Coordinator is responsible for managing specialty medication referrals from receipt through insurance clearance to ensure timely and accurate patient access to therapy. This role serves as the key point of contact for benefit investigation, prior authorization, coordination with internal stakeholders (pharmacy and nursing staff) and financial counseling with patients. The coordinator plays a critical role in ensuring referrals meet payer requirements and in facilitating seamless communication between patients, providers, pharmacy staff and the sales team.
Responsibilities
- Owns and manages the specialty referral from initial intake through insurance approval
- Conducts timely and accurate benefit investigation, verifying both medical and pharmacy benefits
- Identifies and confirms coverage criteria, co-pays, deductibles and prior authorization requirements
- Prepares and submits prior authorization requests to appropriate payers
- Maintains clear, timely communication with pharmacy teams, sales representatives and prescribers regarding the status of each referral and any outstanding information
- Coordinates and delivers financial counseling to patients, including explanation of out-of-pocket costs, financial assistance options and next steps
- Ensures all documentation complies with payer and regulatory requirements
- Updates referral records in real-time within computer system
- Collaborates with patient services and RCM teams to support a smooth transition to fulfillment
- Tracks and reports referral statuses, turnaround times and resolution outcomes to support process improvement
Requirements
- High school diploma or GED required
- Minimum of 2 years of experience in a healthcare, specialty pharmacy, or insurance verification role.
- Experience working with specialty medications, including benefit verification and prior authorization processes.
- Familiarity with payer portals.
- Strong understanding of commercial, Medicare, and Medicaid insurance plans.
- Proven track record of communicating effectively with internal and external stakeholders.
Nice-to-haves
- Associate’s or Bachelor’s degree preferred.
- Experience in patient-facing roles is a plus, especially involving financial or benefit discussion.
- Experience in Microsoft BI.
- Experience in Outlook, Word, and PowerPoint.
Benefits
- No specific benefits were mentioned in the job description.
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