Clearance Specialist, Insurance – Specialty Infusion

🕒 September 8

🇺🇸 United States – Remote

💵 $23 - $27 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔒 Insurance

🚫👨‍🎓 No degree required

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Soleo Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

Soleo Health is a specialty pharmacy company that goes beyond simply filling prescriptions by providing personalized patient experiences and access to specialized medications and infusion therapies. They offer treatment in patients' homes, in providers' offices, or at one of their many nationwide infusion centers. Soleo Health specializes in treating complex and ultra-rare diseases with a focus on improving patient quality of life and optimizing health outcomes. They work closely with patients, providers, pharmaceutical manufacturers, payors, and health systems to deliver high-cost therapies, demonstrating value through real-world outcome data. Soleo Health is recognized for its clinical excellence and dedication to patient care, and offers nationwide services, including an online portal, Soleo Connect®, for real-time communication.

📋 Description

• Process new referrals, including verifying patient eligibility, test claim adjudication, coordination of benefits, and identifying estimated out-of-pocket costs • Perform benefit verification for patient insurance plans, including medication, administration supply, and related infusion service coverage • Document coinsurance, copays, deductibles, authorization requirements, and related insurance information • Calculate estimated patient financial responsibility based on benefit verification and payer contracts or company self-pay pricing • Initiate, follow up on, and secure prior authorizations, pre-determinations, and medical reviews • Review and obtain clinical documents for authorization submissions • Communicate with patients, referral sources, departments, and other external and internal customers regarding referral status and coverage updates • Refer or assist patients with enrollment in manufacturer copay assistance programs and foundations • Generate new patient start-of-care paperwork • Perform other duties as assigned

🎯 Requirements

• At least 2 years of home infusion specialty pharmacy intake experience required • High school diploma or equivalent • Working knowledge of Medicare, Medicaid, and managed care reimbursement guidelines • 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 • Ability to work Monday-Friday, 9am - 5:30pm Eastern time zone

🏖️ Benefits

• 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