Soleo Health

Human Resources

• Process new referrals, including verifying patient eligibility, test claim adjudication, coordination of benefits, and identifying estimated patient out-of-pocket costs
• Perform benefit verification for patient insurance plans, including medication, administration supplies, and related infusion services coverage
• Document coinsurance, copays, deductibles, authorization requirements, and related insurance information
• Calculate estimated patient financial responsibility based on benefit verification, payer contracts, and/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, internal departments, and external 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

Clearance Specialist – Benefits Verification Specialist

Insurance

• 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 infusion service coverage
• Document coinsurance, copays, deductibles, authorization requirements, and related information
• Calculate estimated patient financial responsibility based on benefit verification, 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 external/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

Clearance Specialist – Insurance Intake Coordinator

General

• Maintain prior authorizations, copay assistance, and verify existing insurance coverage for ongoing services
• Obtain detailed insurance benefit information and maximize plan benefits
• Verify insurance benefit information monthly using online tools, calls to payors, and test claims
• Generate prior authorization expiration reports weekly, bi-weekly, or monthly
• Review clinical documents for prior authorization and pre-determination submissions
• Secure prior authorization, pre-determination, or medical review
• Contact prescribers’ offices to obtain information for re-authorization and benefits verification
• Make outbound calls to patients or prescribers’ offices regarding processing delays and missing information
• Document insurance coverage of medications, administration supplies, and related infusion services
• Provide timely and accurate customer service to internal and external customers
• Notify patients about financial responsibility, benefit coverage, and payor authorization
• Generate patient forms
• Maintain current prior authorization reports

Prior Authorization Coordinator

Collections

• Oversee collection activities related to accounts receivable across multiple site locations, payors, and therapies
• Monitor aging reports and key AR metrics to identify trends, risks, and opportunities for improvement
• Ensure accounts are researched and worked appropriately, including billing errors, short payments, overpayments, denials/rejections, unpaid claims, and cash application discrepancies
• Oversee appeals and payer follow-up processes
• Review and approve potential adjustments and refund requests
• Ensure phone conversations and collection activities are documented in company systems
• Identify payer denial, payment delay, and billing issue trends and implement corrective action with billing and revenue cycle teams
• Ensure compliance with regulations, payer requirements, and company policies
• Resolve escalated account issues with insurance companies, patients, and company personnel
• Prepare reports and communicate collection performance, risks, and improvement opportunities to leadership
• Participate in recruitment, onboarding, and training of collection staff
• Utilize payer portals, electronic tools, and internal systems to monitor claim status and resolve outstanding balances
• Support payer projects, audits, and collections or reimbursement process improvements
• Stay informed of payer guidelines, billing deadlines, and appeal requirements
• Supervise, coach, and develop collection specialists
• Assign and monitor workload and timely account follow-up
• Conduct performance reviews and provide staff feedback
• Escalate and resolve complex collection issues, payer disputes, and account resolution challenges
• Perform other duties as assigned

Infusion Collections Manager

Billing Specialist

• Support Soleo Health's Specialty Infusion Pharmacy
• Primarily handle insurance and self-pay billing, excluding Medicare
• Submit electronic and paper claims
• Follow up with clearing house vendors on accepted and working rejections
• Prepare accurate medical claims for commercial, government, employer, and institutional payers
• Review claims pricing discrepancies based on fee schedule updates or changes
• Create and submit secondary electronic pharmacy and medical claims
• Bill manufacturer copays through portals or paper billing
• Monitor billing requirements under payer contracts and government programs
• Answer insurance and billing questions from branch staff and provide education
• Review electronic medical records to prepare and submit clean claims
• Perform monthly revenue review of billed claims
• Answer incoming calls and triage when necessary
• Create claim batches and process electronic submissions
• Manually process claims ineligible for electronic billing
• Identify, correct, and resubmit claims needing attention
• Ensure coding specificity for maximum third-party reimbursement
• Review and follow up daily on unbilled delivery tickets
• Accurately document actions in patient accounts
• Coordinate with the pharmacy team to resolve PBM issues and ensure timely billing
• Meet performance goals through effective use of time and resources
• Provide customer service to internal and external customers
• Ensure compliance with government requirements, payer contracts, and company policies
• Communicate billing issues to Intake, collections, RBL, and management
• Monitor unbilled-pending invoice queues and communicate missing information to branches
• Maintain current knowledge of departmental and organizational policies