Remote Prior Authorization & Intake Specialist

Soleo Health, Inc.; United States; On-site; USD 55,000 - 75,000; Full time

Job summary

Soleo Health, Inc. is seeking a Clearance Specialist to support our specialty infusion pharmacy.

This role is remote within the United States and requires 8:30am-5pm central time coverage and prior authorization workflow experience. The position involves verifying eligibility, handling payer authorizations, benefit verification, calculating patient responsibility, and coordinating with patients and providers while upholding HIPAA standards.

Qualifications

• At least 2 years of home infusion specialty pharmacy intake experience.
• High school diploma or equivalent.
• Working knowledge of Medicare, Medicaid, and managed care reimbursement guidelines.
• Ability to interpret payor contract fee schedules based on NDC and HCPCS units.

Responsibilities

• Process new referrals including verifying patient eligibility, test claim adjudication, coordination of benefits, and identifying patient estimated out-of-pocket costs.
• Prepare, submit, and follow up on payer authorization requests.
• 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, and authorization requirements.
• Calculate estimated patient financial responsibility based on benefit verification, 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 external/internal customers regarding status of referral, coverage, and/or other updates as needed.
• Refer or assist with enrollment of 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 intake

HIPAA knowledge

Multitasking

Communication skills

Education

High school diploma

Tools

Excel

Word

Job description

Soleo Health, Inc. is seeking a Clearance Specialist to support our specialty infusion pharmacy.

This role is remote within the United States and requires 8:30am-5pm central time coverage and prior authorization workflow experience. The position involves verifying eligibility, handling payer authorizations, benefit verification, calculating patient responsibility, and coordinating with patients and providers while upholding HIPAA standards.