Acute Clearance Specialist - Intake Coordinator - Remote

About the role

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

• 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
  • Communicating 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
  • Generating new patient start of care paperwork

Requirements

• Acute home infusion experience required
• Must be able to work 8.00-4:30pm Central Time
• Must have experience with Acute Infusion for Prior authorization/Benefits Verification
• 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

Qualifications

• Must be able to work Full time, 40 hours per week, Monday-Friday
• 8.00-4:30pm Central Time (with a 30 min lunch)
• Weekend on-call once every 3 weeks

Skills

• Knowledge of Acute Infusion for Prior authorization/Benefits Verification
• Working knowledge of Medicare, Medicaid, and managed care reimbursement guidelines
• Basic level skill in Microsoft Excel & Word
• Knowledge of CPR+

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

Pay

• Competitive Wages

Schedule

• Must be able to work Full time, 40 hours per week, Monday-Friday
• 8.00-4:30pm Central Time (with a 30 min lunch)
• Weekend on-call once every 3 weeks

About Us

Soleo Health is an innovative national provider of complex specialty pharmacy and infusion services, administered in the home or at alternate sites of care. Our goal is to attract and retain the best and brightest as our employees are our greatest asset. Experience the Soleo Health Difference!

Soleo’s Core Values

• Improve patients’ lives every day
• Be passionate in everything you do
• Encourage unlimited ideas and creative thinking
• Make decisions as if you own the company
• Do the right thing
• Have fun!

Equal Opportunity Employer

Soleo Health is an Equal Opportunity Employer, celebrating diversity and committed to creating an inclusive environment for all employees. Soleo Health does not discriminate in employment on the basis of race, color, religion, sex, pregnancy, gender identity, national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an organization, parental status, military service or other non-merit factor.