Remote Prior Authorization Specialist – Infusion Care

Soleo Health Inc; United States; On-site; USD 42,000 - 60,000; 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 in a fully remote role across the United States. The ideal candidate has at least 2 years of home infusion experience, including prior authorizations, benefit verifications, and HCPC calculations.

You will verify patient eligibility, prepare and submit payer requests, calculate patient out-of-pocket costs, and communicate with patients and referral sources to advance approved referrals.

Qualifications

• At least 2 years of home infusion specialty pharmacy experience required, including prior authorizations, benefit verifications, running test claims, and HCPC calculations.
• 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.
• Knowledge of HIPAA regulations.
• Basic level skill in Microsoft Excel & Word.
• Knowledge of CPR+ preferred.

Responsibilities

• 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, 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

Prior Authorization

Benefit Verification

HCPCS Coding

Microsoft Excel

Education

High School Diploma

Tools

CPR+

MS Word

Job description

Soleo Health is seeking a Clearance Specialist to support our Specialty Infusion Pharmacy in a fully remote role across the United States. The ideal candidate has at least 2 years of home infusion experience, including prior authorizations, benefit verifications, and HCPC calculations.

You will verify patient eligibility, prepare and submit payer requests, calculate patient out-of-pocket costs, and communicate with patients and referral sources to advance approved referrals.