Clearance Specialist - Chestfield, MO - Intake Coordinator

VIRTIS MANAGEMENT SERVICES INC•Chesterfield, MO

10h•Hybrid

About The Position

Soleo Health is seeking a Clearance Specialist to work hybrid in Chesterfield, MO. This position supports our Specialty Infusion Pharmacy by processing incoming referrals, calling insurance to verify benefits and eligibility, calculating patient financials, calculating expected reimbursement, prior authorization submissions, denials, and appeals. Join us in Simplifying Complex Care! Must work onsite hybrid in Chesterfield, MO, and have specialty pharmacy and Provider Buy & Bill experience. This Position: 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. Responsibilities include: 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 Other duties as assigned

Requirements

At least 2 years of home infusion specialty pharmacy and/or medical intake/reimbursement experience
Working knowledge of Medicare, Medicaid, and managed care reimbursement guidelines including ability to interpret payor contract fee schedules based on NDC and HCPCS units
High school diploma or equivalent
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

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
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
Other duties as assigned