Soleo Health is seeking a Clearance Specialist to work Remotely (USA).

What We Have to Offer You:

• Competitive Wages
• Flexible schedules
• 401(k) with a match
• Referral Bonus
• Annual Merit Based Increases
• 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, during typical business hours
• On-call rotation
• 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

As a condition of hire, full dosage of the COVID-19 vaccination is a requirement for this position. Soleo Health will consider accommodation for disability/medical and/or sincerely held religious beliefs.

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, CPR+, benefits, Authorization, Intake, Billing, test claims

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Application Question(s):

• Have you called payers to perform a benefits verification?
• Are you familiar with medical coding for drugs, nursing and per diem?
• Do you have prior home infusion benefits investigation experience with specialty & acute therapies?
• Do you understand insurance plans and benefit structures?
• What is your desired wage?

Experience:

• Running Test Claims: 2 years (Required)
• Acute Home Infusion: 1 year (Required)
• HCPCS (coding): 1 year (Required)
• obtaining prior authorizations: 2 years (Required)
• CPR+ software system: 1 year (Required)

Work Location: Remote

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