Clearance Team Lead

Soleo Health Inc•Frisco, TX

12d•Remote

About The Position

The Clearance Team Lead provides daily support and guidance to the Patient Access team, assists with escalations, participates in complex therapy benefit verification and prior authorization submissions, and performs duties of both the Clearance Specialist and Prior Authorization Coordinator. They work closely with the Patient Access Supervisor to ensure the team meets or exceeds productivity and quality expectations while delivering exceptional patient care. Responsibilities include: Acts as a resource for colleagues: Provide guidance to the team on referral processing standards, Soleo contracts, fee schedules, therapy guidelines, and supported therapies Monitor and assign referral workload: Oversee the clearance team’s workload and direct the work of other staff members Serve as a Subject Matter Expert: Works autonomously to handle more complex issues related to benefits and authorization within established procedures and practices Handle escalations: Provide exceptional customer service to external and internal customers, resolving any customer requests in a timely and accurate manner Assist in training new team members: Ensure new team members understand their roles and responsibilities and provide ongoing training to enhance their skills and knowledge Support Patient Access team members: Provide necessary guidance, feedback and counseling and may contribute input for performance evaluations Generate and update reports: Create, update and distribute patient access-related reports as needed Perform duties of a Clearance Specialist and Prior Authorization Coordinator

Requirements

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
High school diploma or equivalent

Nice To Haves

Must have experience with Specialty Infusion for Prior authorization/Benefits Verification
Prefer someone with training or lead experience

Responsibilities

Acts as a resource for colleagues: Provide guidance to the team on referral processing standards, Soleo contracts, fee schedules, therapy guidelines, and supported therapies
Monitor and assign referral workload: Oversee the clearance team’s workload and direct the work of other staff members
Serve as a Subject Matter Expert: Works autonomously to handle more complex issues related to benefits and authorization within established procedures and practices
Handle escalations: Provide exceptional customer service to external and internal customers, resolving any customer requests in a timely and accurate manner
Assist in training new team members: Ensure new team members understand their roles and responsibilities and provide ongoing training to enhance their skills and knowledge
Support Patient Access team members: Provide necessary guidance, feedback and counseling and may contribute input for performance evaluations
Generate and update reports: Create, update and distribute patient access-related reports as needed
Perform duties of a Clearance Specialist and Prior Authorization Coordinator