Soleo Health
Description
Soleo Health is seeking a Clearance Specialist to work Remotely (USA). Join us in Simplifying Complex Care!
What We Have to Offer You:
- Competitive Wages
- Flexible schedules
- 401(k) with a match
- Referral Bonus
- Annual Merit Based Increases
- No Weekends or Holidays!
- Affordable Medical, Dental, & Vision Insurance Plans
- Company Paid Disability & Basic Life Insurance
- HSA & FSA (including dependent care) options
- Paid Time Off
- Education Assistant Program
This Position:
The Soleo Health Clearance Specialist will be 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
Schedule:
- Monday-Friday, Full-Time during typical business hours
- Remote
Requirements
- High school diploma or equivalent
- At least 2 years of home infusion pharmacy and/or medical intake/reimbursement experience preferred
- 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