Remote Clearance Specialist: Infusion Benefits & PA

Soleo Health; Frisco (TX); On-site; USD 31,684 - 37,195; 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 Options

Education Assistance Program

Job summary

Soleo Health is seeking a Clearance Specialist to support our Specialty Infusion Pharmacy and work Remotely (USA). Join us in Simplifying Complex Care!

Acute home infusion experience required, and must be able to work 8:30a-5p Mountain Time. Experience running test claims and calculating HCPC codes required. The role involves processing new referrals, verifying patient eligibility, benefit coordination, and payer authorization requests with a focus on accuracy and patient service.

Qualifications

• High school diploma or equivalent is required.
• Experience running test claims and calculating HCPC codes is required.
• 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.

Responsibilities

• Perform benefit verification of all patient insurance plans including documenting coverage of medications, administration supplies, and related infusion services.
• Document all information related to coinsurance, copay, deductibles, authorization requirements, etc.
• Calculate estimated patient financial responsibility based on benefit verification and payer contracts and/or company self-pay pricing.
• Initiate, follow-up, and secure prior authorization, pre-determination, or medical review.
• 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

Tools

Microsoft Excel

Microsoft Word

CPR+

Job description

Soleo Health is seeking a Clearance Specialist to support our Specialty Infusion Pharmacy and work Remotely (USA). Join us in Simplifying Complex Care!

Acute home infusion experience required, and must be able to work 8:30a-5p Mountain Time. Experience running test claims and calculating HCPC codes required. The role involves processing new referrals, verifying patient eligibility, benefit coordination, and payer authorization requests with a focus on accuracy and patient service.