Remote Insurance Clearance Specialist - Prior Auth

Soleo Health; United States; Hybrid; USD 48,000 - 64,000; 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 across the USA. The role focuses on eligibility verification, test claim adjudication, coordination of benefits, and preparing payer authorization requests.

You will calculate patient out-of-pocket costs, perform prior authorizations, and communicate with patients and providers. Requires at least 2 years in home infusion, HIPAA knowledge, and proficiency with Excel/Word.

Qualifications

• At least 2 years of home infusion specialty pharmacy intake experience required.
• High school diploma or equivalent.
• Knowledge of Medicare/Medicaid and managed care guidelines; interpret payor contracts.

Responsibilities

• Verify patient eligibility and document coverage for medications and infusion services.
• Document coinsurance, copays, deductibles, and authorization requirements.
• Calculate estimated patient financial responsibility based on benefit verification and contracts.
• Initiate and follow up on prior authorization, pre-determination, or medical review with clinical docs.
• Communicate status to patients, referral sources, and internal/external stakeholders.
• Refer or assist patients to manufacturer copay assistance or foundations.
• Generate new patient start-of-care paperwork.
• Other duties as assigned.

Skills

Home infusion experience

Prior authorizations

Benefit verification

Test claims

HCPCS calculations

Excel

Education

High school diploma or equivalent

Tools

CPR+ (preferred)

Job description

All Jobs > Specialty Clearance Specialist - Insurance

Specialty Clearance Specialist - Insurance
Fully Remote • Remote

Full-time

Description

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

At least 2 years of home infusion specialty pharmacy experience required, including prior authorizations, benefit verifications, running test claims, and HCPC calculations. The hours are 9am - 5:30pm eastern time zone.

• 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 Insurance Plans
• Company Paid Disability & Basic Life Insurance
• Education Assistance Program

This Position:

The Clearance Specialist is responsible for processing new referrals including but not limited to verifying patient eligibility, test claim adjudication, coordination of benefits, and identifying patient estimated out of pocket costs. They will also be responsible for preparation, submission, and follow up of payer authorization requests. Responsibilities include:

• 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

Schedule:

Requirements

• At least 2 years of home infusion specialty pharmacy intake experience required
• High school diploma or equivalent
• 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

About Us: Soleo Health is an innovative national provider of complex specialty pharmacy and infusion services, administered in the home or at alternate sites of care. Our goal is to attract and retain the best and brightest as our employees are our greatest asset. Experience the Soleo Health Difference!

Soleo’s Core Values:

• Improve patients’ lives every day
• Be passionate in everything you do
• Encourage unlimited ideas and creative thinking
• Make decisions as if you own the company
• Do the right thing
• Have fun!

Soleo Health is committed to diversity, equity, and inclusion. We recognize that establishing and maintaining a diverse, equitable, and inclusive workplace is the foundation of business success and innovation. We are dedicated to hiring diverse talent and to ensuring that everyone is treated with respect and provided an equal opportunity to thrive. Our commitment to these values is evidenced by our diverse executive team, policies, and workplace culture.

Soleo Health is an Equal Opportunity Employer, celebrating diversity and committed to creating an inclusive environment for all employees. Soleo Health does not discriminate in employment on the basis of race, color, religion, sex, pregnancy, gender identity, national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an organization, parental status, military service or other non-merit factor.

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