Infusion Clearance Specialist - 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
• 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

• Infusion benefit verification and prior authorization experience required
• High school diploma or equivalent
• 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

• No weekends or holidays
• Paid Time Off
• Affordable Medical, Dental, & Vision Insurance Plans
• Company Paid Disability & Basic Life Insurance
• HSA & FSA (including dependent care) Options
• Education Assistance Program

Skills

• Knowledge of Medicare, Medicaid, and managed care reimbursement guidelines
• Ability to interpret payor contract fee schedules based on NDC and HCPCS units
• Strong multi-tasking and prioritization skills
• Knowledge of HIPAA regulations
• 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
• Paid Parental Leave Options
• Education Assistance Program

Pay

• Not specified

Schedule

• Monday-Friday, 8:30-5:00pm Eastern Time Zone
• Weekend on-call rotation once every 3-5 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 committed to diversity, equity, and inclusion. We recognize that establishing and maintaining a diverse, equitable, and inclusive workplace is the foundation of business success and innovation. We are dedicated to hiring diverse talent and to ensuring that everyone is treated with respect and provided an equal opportunity to thrive. Our commitment to these values is evidenced by our diverse executive team, policies, and workplace culture.