Infusion Benefit Coordinator – Clearance Specialist

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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

• 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 • 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

🎯 Requirements

• Infusion benefit verification and prior authorization experience required • Experience running test claims and calculating HCPC codes required • High school diploma or equivalent • 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

🏖️ 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