Clearance Specialist - Chestfield, MO - Intake Coordinator at VIRTIS MANAGEMENT SERVICES INC

Chesterfield, Missouri, United States -

Full Time

Start Date

Immediate

Expiry Date

29 Jul, 26

Salary

0.0

Posted On

30 Apr, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Benefit verification, Prior authorization, Insurance eligibility, Medical intake, Reimbursement, Pharmacy operations, Patient financial counseling, HIPAA compliance, Microsoft Excel, Microsoft Word, Referral processing, Claim adjudication, Coordination of benefits, Clinical documentation, HCPCS, NDC

Industry

Hospitals and Health Care

Description

Description Soleo Health is seeking a Clearance Specialist to work hybrid in Chesterfield, MO. This position supports our Specialty Infusion Pharmacy by processing incoming referrals, calling insurance to verify benefits and eligibility, calculating patient financials, calculating expected reimbursement, prior authorization submissions, denials, and appeals. Join us in Simplifying Complex Care! Must work onsite hybrid in Chesterfield, MO, and have specialty pharmacy and Provider Buy & Bill experience. Soleo Health Perks: Competitive Wages 401(k) with a Match Referral Bonus Paid Time Off Great Company Culture Annual Merit Based Increases No Weekends or Holidays Paid Parental Leave Options Affordable Medical, Dental, & Vision Insurance Plans Company Paid Disability & Basic Life Insurance HSA & FSA (including dependent care) Options 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: Monday-Friday, Full-Time M-F 8:00 am to 4:30 pm Central with overtime as needed Requirements At least 2 years of home infusion specialty pharmacy and/or medical intake/reimbursement experience Working knowledge of Medicare, Medicaid, and managed care reimbursement guidelines including ability to interpret payor contract fee schedules based on NDC and HCPCS units High school diploma or equivalent 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. Keywords: Prior Auth, Insurance, Referrals, Now hiring, hiring now, immediately hiring, hiring immediately

Responsibilities

The Clearance Specialist processes new referrals by verifying patient insurance eligibility, calculating financial responsibility, and managing prior authorization requests. They also coordinate with patients and internal departments to ensure accurate documentation and timely reimbursement for infusion services.