Infusions and Specialty Pharmacy Documentation and Criteria Reviewer

Company Description

Today, when you go to your doctor and get referred to a specialist (e.g., for sleep apnea), your doctor sends out a referral and tells you, “They’ll be in touch soon.” So you wait. And wait. Sometimes days, weeks, or even months. Why? Because too often specialists and medical services are overwhelmed with referrals and the painstakingly manual process it takes to qualify your referral prevents them from getting around to it on time, or sometimes at all. Tennr prevents these delays and denials by making sure every referral gets where it needs to go, with the right info, at the right time. Powered by RaeLM™ Tennr reads, extracts, and acts on every piece of patient information so providers can capture more referrals, slash denials, and reduce delays.

Role Description

If you’ve worked in front-end intake, operations compliance, authorizations submission, clinical review, or audit/appeals review in the specialty pharmaceutical / infusions therapy space, this is an opportunity to apply your experience in a new way. We’re growing our documentation and criteria review team to help ensure our platform accurately applies payer authorization and medical necessity criteria.

This is a detail-oriented, hands-on role focused on reviewing clinical documentation, assessing model-generated authorization / clinical review outcomes, and identifying when decisions do or do not align with real-world payer standards.

If you are looking to use your infusions/SP knowledge in a meaningful way and want to help shape how technology supports accurate and efficient qualifications, we would love to connect.

Responsibilities

In this role, you will:

• 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

Candidate Qualifications

Required

• 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

Preferred

• 4+ years working in infusions/SP, ideally in intake, documentation review, case management, and clinical review

• You are tech-savvy and comfortable using AI tools in your day-to-day work to improve accuracy and efficiency

• Familiarity with Medicare, Medicaid, and commercial payer guidelines for infusions/SP

• Understanding of HCPCS codes, NDCs, and common infusions/SP drug categories across therapeutic areas (e.g., neurology, inflammation and immunology, etc.)

• Experience with audits, prior authorizations, and appeals is a strong plus

• Familiarity with decision logic or rules-based platforms is helpful but not required

Why Tennr?

• Drive Impact: one of our company values is Cowboy, meaning you set the pace. You won’t just talk about things, you’ll get them done. And feel the impact.

• Develop Operational Expertise: learn the inner workings of scaling systems, tools, and infrastructure

• Innovate with Purpose: we’re not just doing this for fun (although we do have a lot of fun). At Tennr, you’ll join a high-caliber team maniacally focused on reducing patient delays across the U.S. healthcare system.
  

Benefits

• Fully-Remote

• New, spacious Chelsea office

• Unlimited PTO

• 100% paid employee health benefit options

• Employer-funded 401(k) match

• Competitive parental leave