Clearance Specialist

Soleo Health Inc-posted just now
Full-time • Entry Level
Remote • Frisco, TX
251-500 employees
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Soleo Health is seeking a Full time, Remote, Clearance Specialist to support our Specialty Infusion patients. Join us in Simplifying Complex Care! Soleo Health Perks: 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 The Clearance Specialist is responsible for processing new referrals including but not limited to verifying patient eligibility, test claim adjudication, coordination of benefits, and identifying patient estimated out of pocket costs. They will also be responsible for preparation, submission, and follow up of payer authorization requests.

  • 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
  • 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
  • Must be able to work remote, Monday-Friday 9am-5:30pm, CST- 40 hours per week
  • Must have experience with Specialty Infusion for Prior authorization/Benefits Verification
  • 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
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