Clearance Specialist – Eligibility Representative

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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 • Identifying patient estimated out of pocket costs • Preparation, submission, and follow up of payer authorization requests • Perform benefit verification of all patient insurance plans • Document coverage of medications, administration supplies, and related infusion services • Document all information related to coinsurance, copay, deductibles, authorization requirements • Calculate estimated patient financial responsibility based on benefit verification and payer contracts • Initiate, follow-up, and secure prior authorization, pre-determination, or medical review • 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

🎯 Requirements

• High school diploma or equivalent • Experience running test claims and calculating HCPC codes required. • 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

🏖️ 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