Sobre

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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.
• 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