Clearance Specialist

Soleo Health Inc • Frisco, TX

143d

About The Position

Soleo Health is seeking a Clearance Specialist to support our Specialty Infusion Pharmacy and work Remotely (USA). Join us in Simplifying Complex Care! Specialty home infusion experience required, and must be able to work 9am-5:30pm Pacific Time.

Requirements

• 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.
• Knowledge of CPR+ preferred.

Responsibilities

• Process new referrals including verifying patient eligibility, test claim adjudication, coordination of benefits, and identifying patient estimated out of pocket costs.
• Prepare, submit, and follow up on payer authorization requests.
• Perform benefit verification of all patient insurance plans including documenting coverage of medications, administration supplies, and related infusion services.
• Document all information related to coinsurance, copay, deductibles, authorization requirements, etc.
• Calculate estimated patient financial responsibility based on benefit verification and payer contracts and/or company self-pay pricing.
• Initiate, follow-up, and secure prior authorization, pre-determination, or medical review.
• Review and obtain 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 of any patients who express financial necessity to manufacturer copay assistance programs and/or foundations.
• Generate new patient start of care paperwork.

Benefits

• Competitive Wages
• 401(k) with a Match
• Referral Bonus
• Paid Time Off
• Great Company Culture
• Annual Merit Based Increases
• No Weekends or Holidays
• Paid Parental Leave Options
• Affordable Medical, Dental, & Vision Insurance Plans
• Company Paid Disability & Basic Life Insurance
• HSA & FSA (including dependent care) Options
• Education Assistance Program

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED
• Number of Employees: 251-500 employees