Specialty Clearance Specialist - Prior Authorization, Chronic Infusion

Soleo Health is seeking a Clearance Specialist to support our Specialty Infusion Pharmacy and work Remotely (USA). Join us in Simplifying Complex Care!  

At least 2 years of home infusion specialty pharmacy experience required, including prior authorizations, benefit verifications, running test claims, and HCPC calculations.

Soleo Health Perks:

• 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   

This Position:

The Clearance Specialist is 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 
• Other duties as assigned

Schedule:

• Monday-Friday, Full-Time, 8:30am to 5pm Central Time