Remote Infusion Benefits & Prior Authorization Specialist

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 (including dependent care)

Education Assistance Program

Job summary

Soleo Health is seeking a Clearance Specialist to support our Specialty Infusion Pharmacy, with remote work options in the USA. The role focuses on benefit verification, prior authorization, test claims, and estimating patient out-of-pocket costs.

You will prepare and submit payer authorizations, coordinate benefits, and assist patients with financial options while maintaining HIPAA compliance and accuracy in documentation.

Qualifications

• Infusion benefit verification and prior authorization experience required.
• Experience running test claims and calculating HCPC codes.
• 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.
• Knowledge of HIPAA regulations.

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

Infusion benefit verification

Prior authorization

HCPCS coding

HIPAA knowledge

Microsoft Excel

Microsoft Word

Test claims experience

Education

High school diploma or equivalent

Job description

Soleo Health is seeking a Clearance Specialist to support our Specialty Infusion Pharmacy, with remote work options in the USA. The role focuses on benefit verification, prior authorization, test claims, and estimating patient out-of-pocket costs.

You will prepare and submit payer authorizations, coordinate benefits, and assist patients with financial options while maintaining HIPAA compliance and accuracy in documentation.