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.
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.
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.