Remote, US only · Full-time, Monday--Friday, Eastern business hours
About Squad Health
Squad Health is a New York-based company that helps patients start specialty medications faster by automating prior authorization and benefits work for specialty clinics. Our buy-and-bill team supports in-office infusions and injections for GI, allergy, rheumatology and urology practices nationwide.
About the Role
The Medical Benefits Specialist owns insurance discovery and medical benefits verification (VOB) for every new infusion and injection order. This role involves using automation tools to find the real payer, confirm medical vs. pharmacy benefit, and help determine cost share and PA requirements.
What You'll Do
- Identify the correct payer: trace TPAs and self-funded plans (Quantum Health), BlueCard home plans and FEP
- Determine primary vs. secondary across commercial, Medicare/MA, Medicaid/MCO and TRICARE
- Use the automation tools we provide to work faster and flag where they fall short
- Verify eligibility, provider and facility network status, deductible, coinsurance, OOP max, and PA requirements for the J-code and admin CPT
- Confirm buy-and-bill vs. specialty pharmacy or white-bagging, and the right UM vendor (Cohere, CarelonRx)
- Support our offshore team by completing and checking VOBs and routing each PA to the correct submission path (portal, UM vendor, fax or phone)
- Document findings clearly: rep name, reference number, codes quoted, and insurance card and portal screenshots
What You Bring
- Extensive knowledge of the US payer landscape across lines of business (commercial, Medicare/MA, Medicaid/MCO, TRICARE, FEP), states, Blues plans and TPAs, including coordination of benefits.
- Strong insurance discovery skills. Able to identify the correct payer and plan when the insurance card, portal or eligibility check is unclear or incomplete.
- 3+ years of hands-on medical benefit verification, ideally for provider-administered drugs. You ran the BIs yourself.
- Working knowledge of ICD-10, HCPCS (J-codes), CPT admin codes and facility identifiers (NPI, Tax ID, place of service)
- Daily use of Availity and other payer portals; confident on payer calls
- Comfortable learning new software and AI tools; detail-oriented with PHI
Nice to Have
Specialty practice experience (GI, allergy, rheum or urology) or working for a third-party PA service; experience supporting multiple practices or training others.
Pay: $23.00 - $26.00 per hour
Application Question(s):
- How many years have you personally completed medical benefit verifications (VOBs) for infusions or in-office injectables? Did you run the benefits investigations yourself, or did a manufacturer hub or another team do them?
- Which health plans, payer portals, and prior authorization types are you most familiar with?
- A patient's card says Aetna, but eligibility comes back "not found" in Availity. What do you check next?
- If offered the role, when would you be available to start? Please include your notice period.
Work Location: Remote
