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Job Category:

Helathcare

Pay: TBD


Overview

Soleo Health is seeking a Clearance Specialist to work remotely who is responsible for facilitating the timely evaluation and acceptance of patients referred for service in order to meet the needs of the patient and customers as requested.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Receive medication referrals and collects insurance information via multiple methods, runs test claims, and completes administrative duties.
  • Must have a solid working knowledge of insurance plans and benefit structures in order to obtain detailed benefit information and maximize plan benefits.
  • Review clinical documents for prior authorization/pre-determination submission purposes.
  • Contact referral source, patient, and/or doctor’s office to obtain additional information that is required to complete verification of benefits or prior approvals.
  • Verify and document insurance coverage of medications, administration supplies, and related pharmacy services including prior authorization requirements and coordination of benefits.
  • Places outbound calls to patients or doctor’s offices to notify of any delays due to more information needed to process or due to a prior authorization.
  • Provides exceptional customer service to external and internal customers, resolving any customer requests in a timely and accurate manner.
  • Ensures the appropriate notification of patients in regards to their financial responsibility, benefit coverage, and payor authorization for services to be provided.
  • Maintains prior authorizations and verifies insurance coverage for ongoing services.
  • Completes all required duties, projects and reports in a timely fashion on a daily, weekly, or monthly basis per the direction of the leadership.
  • Other duties as assigned

QUALIFICATION REQUIREMENTS:

  • Bachelor’s degree and at least 2 years of healthcare intake/admissions and/or reimbursement experience OR a high school diploma and at least 4 years of healthcare intake/admissions and/or reimbursement experience.
  • Previous Acute Infusion Intake/Clearance experience is required
  • At least 2 years of experience applying knowledge of Medicare, Medicaid, and Managed Care reimbursement guidelines.
  • Ability to effectively handle multiple priorities within a changing environment
  • Experience in diagnosing, isolating, and resolving complex issues and recommending and implementing strategies to resolve problems.
  • Experience collaborating with internal resources to develop strategies that meet department goals within budget and established timelines.
  • Intermediate level skill in Microsoft Excel (for example: using SUM function, setting borders, setting column width, inserting charts, using text wrap, sorting, setting headers and footers and/or print scaling).
  • Intermediate level skill in Microsoft Word (for example: inserting headers, page breaks, page numbers and tables and/or adjusting table columns).
  • Intermediate level skill in Microsoft PowerPoint (for example: applying a theme, formatting character spacing, inserting a picture, changing slide layout and theme colors, adding transitions, customizing slide numbers, changing chart style and/or formatting font).

Company – Soleo Health

Website – https://www.keentodesign.com.au/

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