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Role Description
This role focuses on developing high-quality benefits investigation phone call scripts for infusion (drug/IV) orders. These scripts will guide other professionals in calling payers to collect accurate eligibility and benefits information, ensuring clarity, compliance, and consistency across all payer interactions.
- Write and refine lines of questioning for phone calls to payers regarding eligibility and benefits for infusion therapies.
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Incorporate payer-specific nuances, such as:
- Medical vs. pharmacy benefit distinctions
- Site-of-care rules
- Step therapy and prior authorization pathways
- Buy-and-bill vs. specialty pharmacy workflows
- Translate payer notes and requirements into structured, natural-language questions.
- Ensure scripts are designed to elicit precise, auditable answers from payer representatives.
- Collaborate with internal reviewers to refine clarity, tone, and compliance.
Qualifications
- Background in infusion therapy, payer communications, or benefits investigation.
- Working knowledge of HCPCS, CPT, J-codes, and relevant ICD-10 diagnoses.
- Understanding of modifiers and place-of-service impact on coverage.
- Strong grasp of insurance concepts for infused and specialty drugs.
- Excellent written documentation and attention to detail.
- Experience conducting payer calls is a strong plus.
Requirements
- Commitment: ~20-30 hours/week
- Type: Contractor (Independent)
- Location: Remote
- Work with a global, high-caliber team through Mercor
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