Clearance Specialist – Benefits Verification Specialist

Soleo Health

. Process new referrals, including verifying patient eligibility, test claim adjudication, coordination of benefits, and identifying estimated patient out-of-pocket costs .

Posted 9/25/2026full-timeRemote • United StatesJuniorMid-Level💰 $23 - $27 per hourWebsite

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

Must have at least 2 years of home infusion specialty pharmacy experience, including prior authorizations, benefit verifications, running test claims, and HCPC calculations
At least 2 years of home infusion specialty pharmacy intake experience required
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
Availability Monday-Friday, 8:30am to 5pm Central Time Zone