Clearance Specialist – Prior Authorization, Chronic Specialty Infusion

🔥 12 minutes ago

🇺🇸 United States – Remote

💵 $23 - $27 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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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 of patient insurance plans and document coverage of medications, administration supplies, and related infusion services • Document coinsurance, copay, deductibles, authorization requirements, and related information • Calculate estimated patient financial responsibility based on benefit verification and payer contracts and/or company self-pay pricing • Initiate, follow up on, and secure prior authorization, pre-determination, or medical review • Review and obtain clinical documents for authorization submissions • Communicate with patients, referral sources, departments, and other customers regarding referral status, coverage, and updates • Refer or assist patients with enrollment in manufacturer copay assistance programs and/or foundations • Generate new patient start-of-care paperwork • Perform other duties as assigned • Work Monday–Friday, full-time, 8:30 a.m. to 5 p.m. Central Time

🎯 Requirements

• At least 2 years of home infusion specialty pharmacy experience required, including prior authorizations, benefit verifications, running test claims, and HCPC calculations • 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 • Work remotely from the USA

🏖️ Benefits

• 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