Hybrid Clearance & Intake Specialist - Specialty Pharmacy

VIRTIS MANAGEMENT SERVICES INC; Chesterfield (MO); Hybrid; USD 52,000 - 73,000; Full time

Benefits offered by this job

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

Company Paid Disability & Basic Life

HSA & FSA (including dependent care)  

Education Assistance Program

Job summary

Soleo Health is seeking a Clearance Specialist to work hybrid in Chesterfield, MO. The role supports our Specialty Infusion Pharmacy by processing referrals, verifying benefits, calculating patient financials, and handling prior authorizations.

The position requires at least 2 years of home infusion specialty pharmacy and/or medical intake/reimbursement experience, with knowledge of Medicare/Medicaid reimbursement guidelines. Schedule is Mon-Fri, onsite hybrid in Chesterfield.

Qualifications

• 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.

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

Skills

home infusion experience

medical intake

reimbursement knowledge

multi-tasking

HIPAA knowledge

MS Excel

MS Word

Education

High school diploma or equivalent

Tools

CPR+

Job description

Soleo Health is seeking a Clearance Specialist to work hybrid in Chesterfield, MO. The role supports our Specialty Infusion Pharmacy by processing referrals, verifying benefits, calculating patient financials, and handling prior authorizations.

The position requires at least 2 years of home infusion specialty pharmacy and/or medical intake/reimbursement experience, with knowledge of Medicare/Medicaid reimbursement guidelines. Schedule is Mon-Fri, onsite hybrid in Chesterfield.