Job Responsibilities : Hiring: Clearance Specialist (Fully Remote/Work from Home Insurance Jobs)
Salary : Competitive Salary
Company : Soleo Health Holdings Inc
Remote Type – Fully Remote
Position Type – Full Time
Soleo Health is seeking a Clearance Specialist to work Remotely in the Midwest area (Eastern Time Zone). The Clearance Specialist 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.
What We Have to Offer You:
401(k) with a match
Annual Merit Based Increases
No Weekends or Holidays!
Affordable Medical, Dental, & Vision Insurance Plans
Company Paid Disability & Basic Life Insurance
Complementary Telehealth Plan
HSA & FSA (including dependent care) options
Paid Time Off
Education Assistant Program
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 doctors 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 doctors 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.
Bachelors 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).
Soleo Health is an Equal Opportunity Employer, celebrating diversity and committed to creating an inclusive environment for all employees. Soleo Health does not discriminate in employment on the basis of race, color, religion, sex, pregnancy, gender identity, national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an organization, parental status, military service or other non-merit factor.
As a condition of hire, full dosage of the COVID-19 vaccination is a requirement for this position. Soleo Health will consider accommodation for disability/medical and/or sincerely held religious beliefs.