Acute Clearance Specialist - Intake Coordinator - Remote

Soleo Health Inc•Frisco, TX

5d•$23 - $27•Remote

About The Position

Soleo Health is seeking an Acute Clearance Specialist to support our Specialty Infusion Pharmacy and work Remotely (USA). Join us in Simplifying Complex Care! This role is responsible for processing new referrals, including verifying patient eligibility, test claim adjudication, coordination of benefits, and identifying patient estimated out-of-pocket costs. The specialist will also prepare, submit, and follow up on payer authorization requests. Key responsibilities include performing benefit verification for all patient insurance plans, documenting coverage for medications, administration supplies, and infusion services, and documenting all information related to coinsurance, copay, deductibles, and authorization requirements. The role involves calculating estimated patient financial responsibility, initiating and securing prior authorizations, pre-determinations, or medical reviews, and communicating with patients, referral sources, and other departments regarding referral status and coverage. Additionally, the specialist will refer or assist patients with financial necessity to manufacturer copay assistance programs and foundations, and generate new patient start-of-care paperwork.

Requirements

Acute home infusion experience required.
High school diploma or equivalent
At least 2 years of home infusion specialty pharmacy and/or medical intake/reimbursement experience preferred
Working knowledge of Medicare, Medicaid, and managed care reimbursement guidelines including ability to interpret payor contract fee schedules based on NDC and HCPCS units
Strong ability to multi-task and support numerous referrals/priorities while ensuring productivity expectations and quality are met
Ability to work in a fast-paced environment
Knowledge of HIPAA regulations
Basic level skill in Microsoft Excel & Word
Must have experience with Acute Infusion for Prior authorization/Benefits Verification

Nice To Haves

Knowledge of CPR+ preferred

Responsibilities

Perform benefit verification of all patient insurance plans including documenting coverage of medications, administration supplies, and related infusion services
Responsible to document all information related to coinsurance, copay, deductibles, authorization requirements, etc
Calculate estimated patient financial responsibility based off benefit verification and payer contracts and/or company self-pay pricing
Initiate, follow-up, and secure prior authorization, pre-determination, or medical review including reviewing and obtaining clinical documents for submission purposes
Communicate with patients, referral sources, other departments, and any other external and internal customers regarding status of referral, coverage and/or other updates as needed
Refer or assist with enrollment any patients who express financial necessity to manufacturer copay assistance programs and/or foundations
Generate new patient start of care paperwork