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. Supervisory Responsibility: No Qualifications EDUCATION/ EXPERIENCE - High school diploma or GED required; Associate's or Bachelor's degree preferred. - 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. - Experience in patient-facing roles is a plus, especially involving financial or benefit discussion. KNOWLEDGE/ SKILLS/ ABILITIES - Familiarity with payer portals. - Strong understanding of commercial, Medicare, and Medicaid insurance plans. - Proven track record of communicating effectively with internal and external stakeholders. - Desired: Experience in Microsoft BI. Experience in Outlook, Word, and PowerPoint. TRAVEL REQUIREMENTS - Percentage of Travel: 0-25% - - To perform this role will require constant sitting and typing on a keyboard with fingers, and occasional standing, and walking. The physical requirements will be the ability to push/pull and lift/carry 1-10 lbs - -