Remote Insurance Clearance Specialist - Prior Auth

Soleo Health; Northern (KY); 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

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.