Clearance Specialist

Soleo Health Inc • Frisco, TX

3h • Remote

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! Home infusion intake experience required. 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.

Requirements

• High school diploma or equivalent
• At least 2 years of home infusion specialty pharmacy intake/reimbursement experience required
• 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 be able to work remote, Monday-Friday 9am to 5:30pm Eastern Time Zone
• Must have experience with Specialty Infusion for Prior authorization/Benefits Verification

Nice To Haves

• Knowledge of CPR+

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

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
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 251-500 employees