Remote Eligibility & Prior Auth Specialist – Home Infusion

Soleo Health Inc; United States; Remote; USD 52,000 - 70,000; 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

Paid Parental Leave Options

Affordable Medical, Dental, & Vision

Company Paid Disability & Basic Life

Education Assistance Program

Job summary

Soleo Health is seeking a Clearance Specialist to support our Specialty Infusion Pharmacy and work remotely in the United States. The role involves verifying patient eligibility, processing test claims, calculating HCPC codes, and coordinating benefits to estimate patient out-of-pocket costs.

The ideal candidate has acute home infusion experience, can work 8:30a-5p MST, and will handle payer authorizations and prior approvals while delivering accurate, timely service in a fast-paced environment.

Qualifications

• High school diploma or equivalent.
• Experience running test claims and calculating HCPC codes 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.
• Basic level skill in Microsoft Excel & Word.
• Knowledge of CPR+ preferred.

Responsibilities

• Verify patient eligibility and document coverage for medications, administration supplies, and infusion services.
• Document coinsurance, copays, deductibles, and authorization requirements.
• Calculate estimated patient financial responsibility based on benefit verification and payer contracts.
• Initiate and follow up on prior authorizations, pre-determination, or medical reviews.
• Review clinical documents for submission purposes.
• Communicate status of referrals and coverage with patients and internal/external stakeholders.
• Refer patients to manufacturer copay assistance programs when needed.
• Generate new patient start-of-care paperwork.

Skills

Acute infusion experience

Test claims processing

HCPCS coding knowledge

HIPAA knowledge

Excel/Word basic

Education

High school diploma

Tools

Microsoft Excel

Microsoft Word

Job description

Soleo Health is seeking a Clearance Specialist to support our Specialty Infusion Pharmacy and work remotely in the United States. The role involves verifying patient eligibility, processing test claims, calculating HCPC codes, and coordinating benefits to estimate patient out-of-pocket costs.

The ideal candidate has acute home infusion experience, can work 8:30a-5p MST, and will handle payer authorizations and prior approvals while delivering accurate, timely service in a fast-paced environment.