Clearance Specialist at Soleo Health Inc

Frisco, Texas, United States -

Full Time

Start Date

Immediate

Expiry Date

14 Jan, 26

Salary

0.0

Posted On

16 Oct, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Acute Home Infusion Experience, Benefit Verification, Insurance Plans, Prior Authorization, Medical Review, Patient Communication, Financial Responsibility Calculation, HIPAA Regulations, Microsoft Excel, Microsoft Word, CPR+ Knowledge, Multi-tasking, Fast-paced Environment, Documentation, Referral Coordination, Payer Contracts

Industry

Hospitals and Health Care

Description

Description Soleo Health is seeking a Clearance Specialist to support our Specialty Infusion Pharmacy and work Remotely (USA). Join us in Simplifying Complex Care! Acute home infusion experience required, and must be able to work 8:30a-5p Mountain Time. 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 Schedule: Must be able to work Full time, 40 hours per week, from 8:30a-5pm Mountain Time Weekend On-call once monthly Must have experience with Acute Infusion for Prior authorization/Benefits Verification Requirements High school diploma or equivalent At least 2 years of home infusion specialty 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 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, Home Infusion Prior Authorization, Home Infusion Benefits verification, Insurance Verification Specialist, Specialty Infusion Benefits Verification, Now Hiring, Hiring Now, Hiring Immediately, Immediately Hiring

Responsibilities

The Clearance Specialist is responsible for processing new referrals, verifying patient eligibility, and coordinating benefits. They will also prepare, submit, and follow up on payer authorization requests.