Insurance Verification Coordinator Jobs in Riverside, CA

Oso Home Care is seeking an experienced, detail-oriented Intake Coordinator to join our Specialty Home Infusion Pharmacy team. Since 1984, Oso Home Care has provided comprehensive specialty home infusion pharmacy, ambulatory infusion center (AIC), and home health services throughout Southern California.

The Intake Coordinator serves as the primary point of contact for new patient referrals and is responsible for coordinating the intake process from referral receipt through clinical review and financial clearance. This position works collaboratively with referral sources, physicians, hospitals, case managers, insurance companies, pharmacists, nurses, reimbursement staff, and patients to ensure referrals are processed accurately, efficiently, and in compliance with payer and regulatory requirements.

The ideal candidate possesses strong organizational skills, excellent customer service abilities, and working knowledge of home infusion therapy, insurance verification, authorization requirements, and medical terminology.

• Receive and process new patient referrals for specialty home infusion pharmacy, ambulatory infusion center (AIC), and home health services.
• Review referrals for completeness and identify missing clinical or demographic information.
• Enter patient demographics, physician information, insurance coverage, diagnosis codes, therapy information, and referral documentation into the electronic medical record.
• Coordinate all aspects of the referral process to facilitate timely admission to service.
• Prioritize referrals based on clinical urgency and service requirements.

• Verify patient insurance eligibility and benefits with Medicare, Medi-Cal, Managed Medi-Cal, Medicare Advantage, PPO, HMO, IPA, and commercial insurance plans.
• Review patient deductibles, co-insurance, copayments, out-of-pocket maximums, and coverage limitations.
• Identify payer-specific requirements for specialty infusion therapies.
• Communicate insurance coverage information to patients and internal departments.
• Document insurance verification findings accurately within the patient record.

• Determine prior authorization requirements based on payer guidelines and prescribed therapy.
• Coordinate authorization requests with the Authorization Specialist and physician offices.
• Obtain and track required documentation to facilitate timely authorization approvals.
• Monitor authorization status and communicate updates to the clinical team.
• Ensure authorizations are obtained prior to initiation of services whenever required.

• Obtain physician orders, history and physicals, progress notes, laboratory results, medication lists, culture reports, infusion orders, and other required clinical documentation.
• Review documentation for completeness prior to pharmacist review.
• Coordinate with physician offices and referral sources to obtain missing documentation.
• Ensure documentation supports payer requirements and therapy initiation.

• Serve as a primary point of contact for physicians, hospitals, case managers, discharge planners, skilled nursing facilities, clinics, and patients.
• Provide timely updates regarding referral status, insurance approval, financial responsibility, and anticipated start of care.
• Explain insurance coverage, authorization requirements, and patient financial obligations in a professional and compassionate manner.
• Deliver exceptional customer service throughout the intake process.

Collaborate closely with:

• Clinical Pharmacists
• Pharmacy Technicians
• Intake Manager
• Authorization Specialists
• Benefits Verification Specialists
• Billing & Reimbursement Department
• Home Infusion Nurses
• Ambulatory Infusion Center (AIC)
• Sales Representatives
• Delivery & Logistics

to ensure efficient coordination of patient care and timely initiation of therapy.

• Coordinate patient admissions upon completion of insurance verification and authorization.
• Assist in scheduling medication deliveries, nursing visits, and infusion appointments.
• Communicate changes in referral status promptly to all affected departments.
• Support timely transitions of care from hospitals, physician offices, and skilled nursing facilities.

• Maintain accurate patient records within the electronic medical record.
• Document all referral activity, payer communications, physician contacts, authorization updates, and patient interactions.
• Ensure documentation complies with company policies, payer requirements, and accreditation standards.

Maintain compliance with:

• HIPAA Privacy and Security Rules
• CMS regulations
• Medicare and Medi-Cal guidelines
• ACHC Accreditation Standards
• California Board of Pharmacy regulations
• Company policies and procedures

Maintain strict confidentiality of patient information.

• Participate in departmental quality improvement initiatives.
• Identify opportunities to improve referral processing efficiency and customer service.
• Assist with internal audits and accreditation preparation.
• Support departmental productivity and quality goals.

• High School Diploma or equivalent required.
• Associate degree in Healthcare Administration, Medical Assisting, Business Administration, or related field preferred.
• Minimum 2 years of healthcare intake, admissions, insurance verification, medical office, specialty pharmacy, or home infusion experience.
• Previous experience in home infusion, specialty pharmacy, home health, hospital discharge planning, or infusion services strongly preferred.

• Knowledge of medical terminology.
• Working knowledge of:
  • HCPCS coding
  • ICD-10 diagnosis coding
  • CPT coding
  • Home infusion therapies
  • Insurance verification
  • Medicare
  • Medi-Cal
  • Commercial insurance
  • Prior authorization processes
• Familiarity with electronic medical records and referral management systems.
• Strong organizational and multitasking skills.
• Excellent verbal and written communication skills.
• Strong customer service and interpersonal skills.
• Ability to prioritize multiple referrals in a fast-paced healthcare environment.
• Proficiency in Microsoft Office Suite, including Word, Excel, Outlook, and healthcare software.

• Customer Service Excellence
• Communication
• Organization
• Attention to Detail
• Problem Solving
• Time Management
• Teamwork
• Accountability
• Adaptability
• Critical Thinking
• Regulatory Compliance
• Patient Advocacy

The Intake Coordinator is expected to:

• Process referrals accurately and efficiently.
• Meet departmental turnaround times for referral processing.
• Maintain accurate patient documentation.
• Ensure insurance verification is completed promptly.
• Coordinate timely authorization requests and patient admissions.
• Provide exceptional customer service to patients and referral sources.
• Support departmental productivity and quality goals.
• Maintain compliance with payer, accreditation, regulatory, and company requirements.

Founded in 1984, Oso Home Care is a privately owned leader in specialty home infusion pharmacy, ambulatory infusion center services, and home health care throughout Southern California. We are committed to providing exceptional patient-centered care through clinical excellence, innovation, compassion, and teamwork.

At Oso Home Care, our employees are valued as essential members of a collaborative healthcare team. We offer a supportive, family-oriented culture with opportunities for professional growth and the satisfaction of making a meaningful difference in the lives of our patients.

Oso Home Care is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive workplace for all employees. Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other status protected by applicable law.