Infusions and Specialty Pharmacy Reviewer

Tennr (YC W23)

Documentation and Criteria Reviewer reviewing clinical documentation and improving authorization outcomes. Working remotely at Tennr, focusing on payer criteria and documentation accuracy.

Posted 5/12/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $55,000 - $57,000 per yearWebsite

About the role

Key responsibilities & impact

Review the model’s outputs to improve criteria determinations
Flag incorrect determinations, including false positives, false negatives, and unclear logic, with structured feedback
Compare documentation against Medicare, Medicaid, and commercial payer coverage policies
Analyze source materials (insurance policies, LCDs, etc.) to help validate qualification logic
Work closely with internal teams to refine prompting logic and improve documentation review standards
Maintain clear documentation of findings and contribute to process improvements

Requirements

What you’ll need

You have hands-on infusions/SP experience in roles such as intake, documentation review, case management, and clinical review
You are confident identifying when documentation meets or fails to meet payer requirements
You are comfortable reviewing insurance coverage policies and applying them to real-world cases
You are highly organized, detail-focused, and confident making policy-based decisions
You work well independently and value open communication within a remote team setting
4+ years working in infusions/SP, ideally in intake, documentation review, case management, and clinical review (preferred)
You are tech-savvy and comfortable using AI tools in your day-to-day work to improve accuracy and efficiency (preferred)
Familiarity with Medicare, Medicaid, and commercial payer guidelines for infusions/SP (preferred)
Understanding of HCPCS codes, NDCs, and common infusions/SP drug categories across therapeutic areas (e.g., neurology, inflammation and immunology, etc.) (preferred)
Experience with audits, prior authorizations, and appeals is a strong plus (preferred)
Familiarity with decision logic or rules-based platforms is helpful but not required (preferred)

Benefits

Comp & perks

Unlimited PTO
Full-Remote Flexibility
100% paid employee health benefit options
Employer-funded 401(k) match
Competitive parental leave

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

documentation reviewcase managementclinical reviewpolicy analysisauditsprior authorizationsappealsHCPCS codesNDCsinfusions

Soft Skills

detail-orientedorganizational skillspolicy-based decision makingindependent workopen communication