Insurance Verification Specialist-Remote

About the role

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.

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

• 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
• Knowledge of CPR+ preferred

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

Schedule

Monday-Friday, Full-Time M-F 8:00 am to 4:30 pm Central with overtime as needed