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Clearance Specialist – Insurance Intake Coordinator
Soleo Health. Process new referrals, including verifying patient eligibility, test claim adjudication, coordination of benefits, and identifying estimated out-of-pocket costs .
About the role
Key responsibilities & impact- 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
Requirements
What you’ll need- 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
- Must work Monday-Friday, 8:30am to 5pm Central Time Zone
Benefits
Comp & 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